Methods for treating chronic lymphocytic leukemia (cll)

ABSTRACT

The present invention relates generally to the treatment of PML by infusion of activated and expanded autologous lymphocytes.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of U.S. patent applicationSer. No. 13/537,330, filed Jun. 29, 2012, (allowed), which is adivisional of U.S. patent application Ser. No. 13/201,829, filed Oct.26, 2011 (issued as U.S. Pat. No. 8,415,150 on Apr. 9, 2013) which is a35 U.S.C. § 371 national phase application from, and claiming priorityto, International Application No. PCT/US2010/025239, filed Feb. 24,2010, which is entitled to priority under 35 U.S.C. § 119(e) to U.S.Provisional Application No. 61/155,026, filed Feb. 24, 2009, all ofwhich applications are hereby incorporated by reference herein in theirentireties.

BACKGROUND OF THE INVENTION

Progressive multifocal leukoencephalopathy (PML), also known asprogressive multifocal leukoencephalitis, is a rare and usually fatalviral disease of the central nervous system most frequently occurring insetting of immunodeficiency (HIV, intensive chemotherapy, organ and bonemarrow transplantation and MS. PML is a demyelinating diseasecharacterized by progressive damage or inflammation of the white matterof the brain at multiple locations. PML is caused by the humanpolyomavirus JC virus, which infects myelin-producing oligodendrocytes.The polyomavirus is called the JC virus (JCV), after the initials of thepatient in whom it was first discovered. The virus is widespread, with86% of the general population presenting antibodies, but it usuallyremains latent, causing disease only when the immune system has beenseverely weakened.

About 2-5% of AIDS patients develop PML. It is unclear why PML occursmore frequently in AIDS than in other immunosuppressive conditions; someresearch suggests that the effects of HIV on brain tissue, or on JCVitself, make JCV more likely to become active in the brain and increaseits damaging inflammatory effects.

PML affects the white matter, which is mostly composed of axons from theoutermost parts of the brain (cortex). Symptoms include weakness orparalysis, vision loss, impaired speech, and cognitive deterioration.PML destroys oligodendrocytes and produces intranuclear inclusions. PMLis similar to another demyelinating disease, multiple sclerosis, butsince it destroys the cells that produce myelin (unlike MS, in whichmyelin itself is attacked but can be replaced), it progresses much morequickly. The median survival of patients with PML as a complication ofAIDS is 6 months. In 10% of patients, survival exceeds 12 months. Thelongest reported survival is 92 months from the onset of illness.

There are no approved therapies for PML and there is no known cure. Insome cases, the disease slows or stops if the patient's immune systemimproves; some AIDS patients with PML have been able to survive forseveral years, with the advent of highly active antiretroviral therapy(HAART).

AIDS patients who start HAART after being diagnosed with PML tend tohave a slightly longer survival time than patients who were already onHAART and then develop PML.

Natalizumab is a humanized monoclonal antibody against leukocyte alphaintegrins. This antibody is used in the treatment of MS and preventsleukocyte trafficking into the central nervous system. Treatment withnatalizumab reduces leukocyte mediated destruction of CNS myelin, whichreduces relapses and slows progression of disability due to MS. However,in February of 2005 natalizumab was voluntarily suspended from marketingbased on three PML case reports. The drug was reintroduced in the UnitedStates and Europe in July of 2006 as monotherapy to treat relapsing MSwith a Black Box Warning: Risk of PML 1:1000 patients. Since thereintroduction in July 2006, one PML case was reported in the U.S. whilefour were reported ex-U.S. Thus development of PML and the lack oftreatment for this disease remains a problem for MS patients receivingnatalizumab treatment.

Other antiviral agents that have been studied as possible treatments forPML include cidofovir and interleukin-2, but this research is stillpreliminary.

Cytarabine (also known as ARA-C), a chemotherapy drug used to treatcertain cancers, has been prescribed on an experimental basis for asmall number of non-AIDS PML patients. It is reported to have stabilizedthe neurological condition of a minority of these patients. One patientregained some cognitive function lost as a result of PML.

There is usually no significant humoral or cellular immune response toJCV which makes it difficult to diagnose PML. Although JCV appears to bepresent in about 80% of the adult population, PML generally onlydevelops in connection with a weakening of the immune system. Theincreasing use of immuno-suppressive drugs and the increasing number ofHIV-infected patients has led to a considerable increase in PML diseasesin recent years.

The known methods of diagnosis for detecting a PML disease essentiallycomprise image forming methods such as CT (computer tomography) and MRI(magnetic resonance imaging) as well as immunocytochemical methods basedon biopsies or autopsies. Recently PCR detection methods have increasedin importance, virus DNA amplification from cerebrospinal fluid (CSF)yielding reliable and specific results (Weber et al., J. Infect. Dis.(1994), 1138-1141 and McGuire et al., Annals of Neurology 37 (1995),395-399).

There remains a need for effective treatment for this disease. Thepresent invention provides this and other advantages as describedfurther herein.

BRIEF SUMMARY OF THE INVENTION

The invention provides a method for treating Progressive MultifocalLeukoencephalopathy (PML). The method comprises administering to apatient a population of T cells activated and expanded according to amethod comprising, activating a population of T cells in vitro with anagent which stimulates a TCR/CD3 complex-associated signal in the Tcells, wherein the agent is attached on a surface; and stimulating aCD28 accessory molecule on the surface of the T cells in vitro with aligand that binds the CD28 accessory molecule on the surface of the Tcells, wherein the ligand is attached on the same surface as the agent;the activating and stimulating steps thereby inducing proliferation ofthe T cells.

In one embodiment, the agent is selected from the group consisting of ananti-CD3 antibody, or antigen-binding fragment thereof, an anti-TCRantibody, or antigen-binding fragment thereof, a superantigen, anMHC-peptide tetramer, and an antigen in a form suitable to trigger aprimary activation signal in the T cell when complexed with the TCR/CD3complex.

In one embodiment, the ligand is selected from the group consisting ofan anti-CD28 antibody, or antigen-binding fragment thereof, B7-1 or aCD28-binding fragment thereof, and B7-2 or a CD28-binding fragmentthereof.

In one embodiment, the surface is selected from the group consisting ofa bead, a lipid bilayer, a cell surface, and a tissue-culture dish.

In one embodiment, the activated and expanded T cells are administeredintravenously to the patient.

In one embodiment, the cell surface is of a human cell line. Preferably,the cell line is K562.

In one embodiment, the cell is genetically modified to express a humanFcγ receptor. Preferably, the human Fcγ receptor comprises CD32 or CD64.

In one embodiment, the cell is further genetically modified to express aco-stimulatory molecule selected from the group consisting of CD80,CD86, 4-1BBL, OX40L, ICOS-L, ICAM, PD-L1 and PD-L2.

In one embodiment, the cell has been modified to express a cytokine. Inone embodiment, the cytokine is selected from the group consisting ofIL-2, GM-CSF, IL-4, TNF-α, and IFN-γ.

The invention also provides a method for treating Chronic LymphocyticLeukemia (CLL). The method comprises administering to a patient apopulation of T cells activated and expanded according to a methodcomprising, activating a population of T cells in vitro with an agentwhich stimulates a TCR/CD3 complex-associated signal in the T cells,wherein the agent is attached on a surface; and stimulating a CD28accessory molecule on the surface of the T cells in vitro with a ligandthat binds the CD28 accessory molecule on the surface of the T cells,wherein the ligand is attached on the same surface as the agent; theactivating and stimulating steps thereby inducing proliferation of the Tcells.

The invention also provides a method for treating a patient at risk ofhaving Progressive Multifocal Leukoencephalopathy (PML) wherein thepatient has undergone therapy that raises the risk for the developmentof PML. The method comprises administering to a patient a population ofT cells activated and expanded according to a method comprising,activating a population of T cells in vitro with an agent whichstimulates a TCR/CD3 complex-associated signal in the T cells, whereinthe agent is attached on a surface; and stimulating a CD28 accessorymolecule on the surface of the T cells in vitro with a ligand that bindsthe CD28 accessory molecule on the surface of the T cells, wherein theligand is attached on the same surface as the agent; the activating andstimulating steps thereby inducing proliferation of the T cells.

BRIEF DESCRIPTION OF THE DRAWINGS

The following detailed description of preferred embodiments of theinvention will be better understood when read in conjunction with theappended drawings. For the purpose of illustrating the invention, thereare shown in the drawings embodiments which are presently preferred. Itshould be understood, however, that the invention is not limited to theprecise arrangements and instrumentalities of the embodiments shown inthe drawings.

FIG. 1 is a dot plot showing CD45+/CD3+ T cells 10 days postanti-CD3/anti-CD28 stimulation from a CLL patient presenting withsymptoms diagnostic of PML.

FIG. 2 shows flow cytometric analysis of virus-specific CD8+ T cellsfrom a CLL patient with PML pre and post anti-CD3/anti-CD28 stimulation.CEF: CMV, EBV, Flu.

FIG. 3 shows flow cytometric analysis of virus-specific CD8+ T cellsfrom a CLL patient with PML post anti-CD3/anti-CD28 stimulation andinfusion. CEF: CMV, EBV, Flu.

FIG. 4 is a chart demonstrating that T cells selected and expanded withanti-CD3/CD28 beads were able to be expanded under small scaleconditions at least 4.3 population doublings (20-fold) under optimalconditions.

FIG. 5 is a chart demonstrating that T cells selected and expanded withanti-CD3/CD28 beads using the optimal small scale conditions in aclinical scale bioreactor can expand at least 5.22 population doublings(37-fold) under optimal large scale conditions.

FIG. 6 is an image demonstrating the percentage of CD3+ T cells of theCD45+ cells increased from 4.3% in the apheresis product to >99% in theexpanded T cell product after 10 days of culture.

FIG. 7 is a schematic of the general study of usingFludarabine-Cyclophosphamide followed by adoptive transfer of CD3/CD28ex vivo costimulated autologous T cells for Chronic Lymphocytic Leukemia(CLL) and Progressive Multifocal Leukoencephalopathy (PML).

DETAILED DESCRIPTION

The present invention relates generally to the treatment of a patienthaving Progressive Multifocal Leukoencephalopathy (PML) or at risk ofhaving PML using lymphocyte infusion. In another embodiment, theinvention relates generally to the treatment of a patient having ChronicLymphocytic Leukemia (CLL) or at risk of having CLL using lymphocyteinfusion. Preferably, autologous lymphocyte infusion is used in thetreatment. Autologous PBMCs are collected from a patient in need oftreatment and T cells are activated and expanded using the methodsdescribed herein and known in the art and then infused back into thepatient.

In yet another embodiment, the invention relates generally to thetreatment of a patient at risk of developing PML or CLL. For example,treating a malignancy or an autoimmune disease in which chemotherapyand/or immunotherapy in a patient results in significantimmunosuppression in the patient that raises the risk of the patient ofdeveloping PML or CLL.

One aspect of the invention provides a method of treating PML comprisingadministering to a patient a population of T cells activated andexpanded according to a method comprising, (a) activating a populationof T cells in vitro with an agent which stimulates a TCR/CD3complex-associated signal in the T cells, wherein the agent is attachedon a surface; and (b) stimulating a CD28 accessory molecule on thesurface of the T cells in vitro with a ligand that binds the CD28accessory molecule on the surface of the T cells, wherein the ligand isattached on the same surface as the agent; the activating andstimulating steps thereby inducing proliferation of the T cells. In thisregard, illustrative agents include an anti-CD3 antibody, orantigen-binding fragment thereof, an anti-TCR antibody, orantigen-binding fragment thereof, a superantigen, an MHC-peptidetetramer, and an antigen in a form suitable to trigger a primaryactivation signal in the T cell when complexed with the TCR/CD3 complex.Illustrative ligands of the invention include, but are not limited to,an anti-CD28 antibody, or antigen-binding fragment thereof, B7-1 or aCD28-binding fragment thereof, and B7-2 or a CD28-binding fragmentthereof.

In one embodiment of the invention the surface is selected from thegroup consisting of a bead, a lipid bilayer, a cell surface, and atissue-culture dish. In another embodiment, the activated and expanded Tcells are administered to the patient intravenously. In a furtherembodiment of the invention, the activated and expanded T cells of theinvention are administered in conjunction with other therapies, such asnatalizumab or other acceptable treatments for PML.

In certain embodiments, autologous antigen-specific T cells may be used.In this regard, JCV-specific T cells can be expanded using one or moreJCV proteins or epitopes thereof as antigen (see e.g., U.S. Pat. No.6,238,859). In other embodiments, BKV-specific T cells can be expandedusing one or more BKV proteins or epitopes thereof as antigen. Theseantigen-specific T cells may be used alone or in conjunction withpolyclonal autologous T cells activated and expanded usinganti-CD3/anti-CD28 beads or aAPC using the methods as described herein.The invention also encompasses an aAPC comprising a nucleic acidencoding an antigen of interest such as JC and/or BK virus peptides.

Definitions

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which the invention pertains. Although any methods andmaterials similar or equivalent to those described herein can be used inthe practice for testing of the present invention, the preferredmaterials and methods are described herein. In describing and claimingthe present invention, the following terminology will be used.

It is also to be understood that the terminology used herein is for thepurpose of describing particular embodiments only, and is not intendedto be limiting.

The articles “a” and “an” are used herein to refer to one or to morethan one (i.e., to at least one) of the grammatical object of thearticle. By way of example, “an element” means one element or more thanone element.

An “amino acid” as used herein is meant to include both natural andsynthetic amino acids, and both D and L amino acids. “Standard aminoacid” means any of the twenty L-amino acids commonly found in naturallyoccurring peptides. “Nonstandard amino acid residues” means any aminoacid, other than the standard amino acids, regardless of whether it isprepared synthetically or derived from a natural source. As used herein,“synthetic amino acid” also encompasses chemically modified amino acids,including but not limited to salts, amino acid derivatives (such asamides), and substitutions. Amino acids contained within the peptides,and particularly at the carboxy- or amino-terminus, can be modified bymethylation, amidation, acetylation or substitution with other chemicalgroups which can change a peptide's circulating half life withoutadversely affecting activity of the peptide. Additionally, a disulfidelinkage may be present or absent in the peptides.

“About” as used herein when referring to a measurable value such as anamount, a temporal duration, and the like, is meant to encompassvariations of ±20% or ±10%, more preferably ±5%, even more preferably±1%, and still more preferably ±0.1% from the specified value, as suchvariations are appropriate to perform the disclosed methods.

The term “antigen” or “Ag” as used herein is defined as a molecule thatprovokes an immune response. This immune response may involve eitherantibody production, or the activation of specificimmunologically-competent cells, or both. The skilled artisan willunderstand that any macromolecule, including virtually all proteins orpeptides, can serve as an antigen. Furthermore, antigens can be derivedfrom recombinant or genomic DNA. A skilled artisan will understand thatany DNA, which comprises a nucleotide sequences or a partial nucleotidesequence encoding a protein that elicits an immune response thereforeencodes an “antigen” as that term is used herein. Furthermore, oneskilled in the art will understand that an antigen need not be encodedsolely by a full length nucleotide sequence of a gene. It is readilyapparent that the present invention includes, but is not limited to, theuse of partial nucleotide sequences of more than one gene and that thesenucleotide sequences are arranged in various combinations to elicit thedesired immune response. Moreover, a skilled artisan will understandthat an antigen need not be encoded by a “gene” at all. It is readilyapparent that an antigen can be generated synthesized or can be derivedfrom a biological sample. Such a biological sample can include, but isnot limited to a tissue sample, a tumor sample, a cell or a biologicalfluid.

The term “antibody,” as used herein, refers to an immunoglobulinmolecule which specifically binds with an antigen. Antibodies can beintact immunoglobulins derived from natural sources or from recombinantsources and can be immunoreactive portions of intact immunoglobulins.Antibodies are typically tetramers of immunoglobulin molecules. Theantibodies in the present invention may exist in a variety of formsincluding, for example, polyclonal antibodies, monoclonal antibodies,Fv, Fab and F(ab)₂, as well as single chain antibodies and humanizedantibodies (Harlow et al., 1999, In: Using Antibodies: A LaboratoryManual, Cold Spring Harbor Laboratory Press, NY; Harlow et al., 1989,In: Antibodies: A Laboratory Manual, Cold Spring Harbor, N.Y.; Houstonet al., 1988, Proc. Natl. Acad. Sci. USA 85:5879-5883; Bird et al.,1988, Science 242:423-426).

The term “agent”, “ligand”, or “agent that binds a cell surface moiety”,as used herein, refers to a molecule that binds to a defined populationof cells. The agent may bind any cell surface moiety, such as areceptor, an antigenic determinant, or other binding site present on thetarget cell population. The agent may be a protein, peptide, antibodyand antibody fragments thereof, fusion proteins, synthetic molecule, anorganic molecule (e.g., a small molecule), a carbohydrate, or the like.Within the specification and in the context of T cell stimulation,antibodies and natural ligands are used as prototypical examples of suchagents.

The terms “agent that binds a cell surface moiety” and “cell surfacemoiety”, as used herein, are used in the context of a ligand/anti-ligandpair. Accordingly, these molecules should be viewed as acomplementary/anti-complementary set of molecules that demonstratespecific binding, generally of relatively high affinity.

As used herein, the term “autologous” is meant to refer to any materialderived from the same individual to which it is later to bere-introduced into the individual.

“Allogeneic” refers to a graft derived from a different animal of thesame species.

“Xenogeneic” refers to a graft derived from an animal of a differentspecies.

The term “cancer” as used herein is defined as disease characterized bythe rapid and uncontrolled growth of aberrant cells. Cancer cells canspread locally or through the bloodstream and lymphatic system to otherparts of the body. Examples of various cancers include but are notlimited to, breast cancer, prostate cancer, ovarian cancer, cervicalcancer, skin cancer, pancreatic cancer, colorectal cancer, renal cancer,liver cancer, brain cancer, lymphoma, leukemia, lung cancer and thelike.

A “coding region” of a gene consists of the nucleotide residues of thecoding strand of the gene and the nucleotides of the non-coding strandof the gene which are homologous with or complementary to, respectively,the coding region of an mRNA molecule which is produced by transcriptionof the gene.

A “coding region” of an mRNA molecule also consists of the nucleotideresidues of the mRNA molecule which are matched with an anti-codonregion of a transfer RNA molecule during translation of the mRNAmolecule or which encode a stop codon. The coding region may thusinclude nucleotide residues corresponding to amino acid residues whichare not present in the mature protein encoded by the mRNA molecule(e.g., amino acid residues in a protein export signal sequence).

“Encoding” refers to the inherent property of specific sequences ofnucleotides in a polynucleotide, such as a gene, a cDNA, or an mRNA, toserve as templates for synthesis of other polymers and macromolecules inbiological processes having either a defined sequence of nucleotides(i.e., rRNA, tRNA and mRNA) or a defined sequence of amino acids and thebiological properties resulting therefrom. Thus, a gene encodes aprotein if transcription and translation of mRNA corresponding to thatgene produces the protein in a cell or other biological system. Both thecoding strand, the nucleotide sequence of which is identical to the mRNAsequence and is usually provided in sequence listings, and thenon-coding strand, used as the template for transcription of a gene orcDNA, can be referred to as encoding the protein or other product ofthat gene or cDNA.

Unless otherwise specified, a “nucleotide sequence encoding an aminoacid sequence” includes all nucleotide sequences that are degenerateversions of each other and that encode the same amino acid sequence.Nucleotide sequences that encode proteins and RNA may include introns.

“Effective amount” or “therapeutically effective amount” are usedinterchangeably herein, and refer to an amount of a compound,formulation, material, or composition, as described herein effective toachieve a particular biological result. Such results may include, butare not limited to, the inhibition of virus infection as determined byany means suitable in the art.

As used herein “endogenous” refers to any material from or producedinside an organism, cell, tissue or system.

As used herein, the term “exogenous” refers to any material introducedfrom or produced outside an organism, cell, tissue or system.

The term “expression” as used herein is defined as the transcriptionand/or translation of a particular nucleotide sequence driven by itspromoter.

“Expression vector” refers to a vector comprising a recombinantpolynucleotide comprising expression control sequences operativelylinked to a nucleotide sequence to be expressed. An expression vectorcomprises sufficient cis-acting elements for expression; other elementsfor expression can be supplied by the host cell or in an in vitroexpression system. Expression vectors include all those known in theart, such as cosmids, plasmids (e.g., naked or contained in liposomes)and viruses (e.g., lentiviruses, retroviruses, adenoviruses, andadeno-associated viruses) that incorporate the recombinantpolynucleotide.

As used herein, the term “fragment,” as applied to a nucleic acid,refers to a subsequence of a larger nucleic acid. A “fragment” of anucleic acid can be at least about 15 nucleotides in length; forexample, at least about 50 nucleotides to about 100 nucleotides; atleast about 100 to about 500 nucleotides, at least about 500 to about1000 nucleotides, at least about 1000 nucleotides to about 1500nucleotides; or about 1500 nucleotides to about 2500 nucleotides; orabout 2500 nucleotides (and any integer value in between).

As used herein, the term “fragment,” as applied to a protein or peptide,refers to a subsequence of a larger protein or peptide. A “fragment” ofa protein or peptide can be at least about 20 amino acids in length; forexample at least about 50 amino acids in length; at least about 100amino acids in length, at least about 200 amino acids in length, atleast about 300 amino acids in length, and at least about 400 aminoacids in length (and any integer value in between).

“Homologous” as used herein, refers to the subunit sequence identitybetween two polymeric molecules, e.g., between two nucleic acidmolecules, such as, two DNA molecules or two RNA molecules, or betweentwo polypeptide molecules. When a subunit position in both of the twomolecules is occupied by the same monomeric subunit; e.g., if a positionin each of two DNA molecules is occupied by adenine, then they arehomologous at that position. The homology between two sequences is adirect function of the number of matching or homologous positions; e.g.,if half (e.g., five positions in a polymer ten subunits in length) ofthe positions in two sequences are homologous, the two sequences are 50%homologous; if 90% of the positions (e.g., 9 of 10), are matched orhomologous, the two sequences are 90% homologous. By way of example, theDNA sequences 5′-ATTGCC-3′ and 5′-TATGGC-3′ share 50% homology.

The term “immunoglobulin” or “Ig”, as used herein is defined as a classof proteins, which function as antibodies. The five members included inthis class of proteins are IgA, IgG, IgM, IgD, and IgE. IgA is theprimary antibody that is present in body secretions, such as saliva,tears, breast milk, gastrointestinal secretions and mucus secretions ofthe respiratory and genitourinary tracts. IgG is the most commoncirculating antibody. IgM is the main immunoglobulin produced in theprimary immune response in most mammals. It is the most efficientimmunoglobulin in agglutination, complement fixation, and other antibodyresponses, and is important in defense against bacteria and viruses. IgDis the immunoglobulin that has no known antibody function, but may serveas an antigen receptor. IgE is the immunoglobulin that mediatesimmediate hypersensitivity by causing release of mediators from mastcells and basophils upon exposure to allergen.

As used herein, an “instructional material” includes a publication, arecording, a diagram, or any other medium of expression which can beused to communicate the usefulness of the compositions and methods ofthe invention. The instructional material of the kit of the inventionmay, for example, be affixed to a container which contains the nucleicacid, peptide, and/or composition of the invention or be shippedtogether with a container which contains the nucleic acid, peptide,and/or composition. Alternatively, the instructional material may beshipped separately from the container with the intention that theinstructional material and the compound be used cooperatively by therecipient.

“Isolated” means altered or removed from the natural state. For example,a nucleic acid or a peptide naturally present in a living animal is not“isolated,” but the same nucleic acid or peptide partially or completelyseparated from the coexisting materials of its natural state is“isolated.” An isolated nucleic acid or protein can exist insubstantially purified form, or can exist in a non-native environmentsuch as, for example, a host cell.

An “isolated nucleic acid” refers to a nucleic acid segment or fragmentwhich has been separated from sequences which flank it in a naturallyoccurring state, i.e., a DNA fragment which has been removed from thesequences which are normally adjacent to the fragment, i.e., thesequences adjacent to the fragment in a genome in which it naturallyoccurs. The term also applies to nucleic acids which have beensubstantially purified from other components which naturally accompanythe nucleic acid, i.e., RNA or DNA or proteins, which naturallyaccompany it in the cell. The term therefore includes, for example, arecombinant DNA which is incorporated into a vector, into anautonomously replicating plasmid or virus, or into the genomic DNA of aprokaryote or eukaryote, or which exists as a separate molecule (i.e.,as a cDNA or a genomic or cDNA fragment produced by PCR or restrictionenzyme digestion) independent of other sequences. It also includes arecombinant DNA which is part of a hybrid gene encoding additionalpolypeptide sequence.

In the context of the present invention, the following abbreviations forthe commonly occurring nucleic acid bases are used. “A” refers toadenosine, “C” refers to cytosine, “G” refers to guanosine, “T” refersto thymidine, and “U” refers to uridine.

Unless otherwise specified, a “nucleotide sequence encoding an aminoacid sequence” includes all nucleotide sequences that are degenerateversions of each other and that encode the same amino acid sequence. Thephrase nucleotide sequence that encodes a protein or an RNA may alsoinclude introns to the extent that the nucleotide sequence encoding theprotein may in some version contain an intron(s).

As used herein, the term “modulate” is meant to refer to any change inbiological state, i.e. increasing, decreasing, and the like.

The term “operably linked” refers to functional linkage between aregulatory sequence and a heterologous nucleic acid sequence resultingin expression of the latter. For example, a first nucleic acid sequenceis operably linked with a second nucleic acid sequence when the firstnucleic acid sequence is placed in a functional relationship with thesecond nucleic acid sequence. For instance, a promoter is operablylinked to a coding sequence if the promoter affects the transcription orexpression of the coding sequence. Generally, operably linked DNAsequences are contiguous and, where necessary to join two protein codingregions, in the same reading frame.

“Parenteral” administration of an immunogenic composition includes,e.g., subcutaneous (s.c.), intravenous (i.v.), intramuscular (i.m.), orintrasternal injection, or infusion techniques.

The term “polynucleotide” as used herein is defined as a chain ofnucleotides. Furthermore, nucleic acids are polymers of nucleotides.Thus, nucleic acids and polynucleotides as used herein areinterchangeable. One skilled in the art has the general knowledge thatnucleic acids are polynucleotides, which can be hydrolyzed into themonomeric “nucleotides.” The monomeric nucleotides can be hydrolyzedinto nucleosides. As used herein polynucleotides include, but are notlimited to, all nucleic acid sequences which are obtained by any meansavailable in the art, including, without limitation, recombinant means,i.e., the cloning of nucleic acid sequences from a recombinant libraryor a cell genome, using ordinary cloning technology and PCR™, and thelike, and by synthetic means.

As used herein, the terms “peptide,” “polypeptide,” and “protein” areused interchangeably, and refer to a compound comprised of amino acidresidues covalently linked by peptide bonds. A protein or peptide mustcontain at least two amino acids, and no limitation is placed on themaximum number of amino acids that can comprise a protein's or peptide'ssequence. Polypeptides include any peptide or protein comprising two ormore amino acids joined to each other by peptide bonds. As used herein,the term refers to both short chains, which also commonly are referredto in the art as peptides, oligopeptides and oligomers, for example, andto longer chains, which generally are referred to in the art asproteins, of which there are many types. “Polypeptides” include, forexample, biologically active fragments, substantially homologouspolypeptides, oligopeptides, homodimers, heterodimers, variants ofpolypeptides, modified polypeptides, derivatives, analogs, fusionproteins, among others. The polypeptides include natural peptides,recombinant peptides, synthetic peptides, or a combination thereof.

The term “promoter” as used herein is defined as a DNA sequencerecognized by the synthetic machinery of the cell, or introducedsynthetic machinery, required to initiate the specific transcription ofa polynucleotide sequence.

As used herein, the term “promoter/regulatory sequence” means a nucleicacid sequence which is required for expression of a gene productoperably linked to the promoter/regulatory sequence. In some instances,this sequence may be the core promoter sequence and in other instances,this sequence may also include an enhancer sequence and other regulatoryelements which are required for expression of the gene product. Thepromoter/regulatory sequence may, for example, be one which expressesthe gene product in a tissue specific manner.

A “constitutive” promoter is a nucleotide sequence which, when operablylinked with a polynucleotide which encodes or specifies a gene product,causes the gene product to be produced in a cell under most or allphysiological conditions of the cell.

An “inducible” promoter is a nucleotide sequence which, when operablylinked with a polynucleotide which encodes or specifies a gene product,causes the gene product to be produced in a cell substantially only whenan inducer which corresponds to the promoter is present in the cell.

A “tissue-specific” promoter is a nucleotide sequence which, whenoperably linked with a polynucleotide encodes or specified by a gene,causes the gene product to be produced in a cell substantially only ifthe cell is a cell of the tissue type corresponding to the promoter.

The term “RNA” as used herein is defined as ribonucleic acid.

The term “recombinant DNA” as used herein is defined as DNA produced byjoining pieces of DNA from different sources.

The term “recombinant polypeptide” as used herein is defined as apolypeptide produced by using recombinant DNA methods.

The term “subject” is intended to include living organisms in which animmune response can be elicited (e.g., mammals).

As used herein, a “substantially purified” cell is a cell that isessentially free of other cell types. A substantially purified cell alsorefers to a cell which has been separated from other cell types withwhich it is normally associated in its naturally occurring state. Insome instances, a population of substantially purified cells refers to ahomogenous population of cells. In other instances, this term referssimply to cell that have been separated from the cells with which theyare naturally associated in their natural state. In some embodiments,the cells are cultured in vitro. In other embodiments, the cells are notcultured in vitro.

The term “therapeutic” as used herein means a treatment and/orprophylaxis. A therapeutic effect is obtained by suppression, remission,or eradication of a disease state.

The term “transfected” or “transformed” or “transduced” as used hereinrefers to a process by which exogenous nucleic acid is transferred orintroduced into the host cell. A “transfected” or “transformed” or“transduced” cell is one which has been transfected, transformed ortransduced with exogenous nucleic acid. The cell includes the primarysubject cell and its progeny.

The phrase “under transcriptional control” or “operatively linked” asused herein means that the promoter is in the correct location andorientation in relation to a polynucleotide to control the initiation oftranscription by RNA polymerase and expression of the polynucleotide.

“Variant” as the term is used herein, is a nucleic acid sequence or apeptide sequence that differs in sequence from a reference nucleic acidsequence or peptide sequence respectively, but retains essentialproperties of the reference molecule. Changes in the sequence of anucleic acid variant may not alter the amino acid sequence of a peptideencoded by the reference nucleic acid, or may result in amino acidsubstitutions, additions, deletions, fusions and truncations. Changes inthe sequence of peptide variants are typically limited or conservative,so that the sequences of the reference peptide and the variant areclosely similar overall and, in many regions, identical. A variant andreference peptide can differ in amino acid sequence by one or moresubstitutions, additions, deletions in any combination. A variant of anucleic acid or peptide can be a naturally occurring such as an allelicvariant, or can be a variant that is not known to occur naturally.Non-naturally occurring variants of nucleic acids and peptides may bemade by mutagenesis techniques or by direct synthesis.

A “vector” is a composition of matter which comprises an isolatednucleic acid and which can be used to deliver the isolated nucleic acidto the interior of a cell. Numerous vectors are known in the artincluding, but not limited to, linear polynucleotides, polynucleotidesassociated with ionic or amphiphilic compounds, plasmids, and viruses.Thus, the term “vector” includes an autonomously replicating plasmid ora virus. The term should also be construed to include non-plasmid andnon-viral compounds which facilitate transfer of nucleic acid intocells, such as, for example, polylysine compounds, liposomes, and thelike. Examples of viral vectors include, but are not limited to,adenoviral vectors, adeno-associated virus vectors, retroviral vectors,and the like.

By the term “stimulation,” is meant a primary response induced bybinding of a stimulatory molecule (e.g., a TCR/CD3 complex) with itscognate ligand thereby mediating a signal transduction event, such as,but not limited to, signal transduction via the TCR/CD3 complex.Stimulation can mediate altered expression of certain molecules, such asdownregulation of TGF-β, and/or reorganization of cytoskeletalstructures, and the like.

“Activation”, as used herein, refers to the state of a T cell that hasbeen sufficiently stimulated to induce detectable cellularproliferation. Activation can also be associated with induced cytokineproduction, and detectable effector functions. The term “activated Tcells” refers to, among other things, T cells that are undergoing celldivision.

By the term “specifically binds,” as used herein, is meant an antibody,or a ligand, which recognizes and binds with a cognate binding partner(e.g., a stimulatory and/or costimulatory molecule present on a T cell)protein present in a sample, but which antibody or ligand does notsubstantially recognize or bind other molecules in the sample.

A “stimulatory ligand,” as used herein, means a ligand that when presenton an antigen presenting cell (e.g., an aAPC, a dendritic cell, aB-cell, and the like) can specifically bind with a cognate bindingpartner (referred to herein as a “stimulatory molecule”) on a T cell,thereby mediating a primary response by the T cell, including, but notlimited to, activation, initiation of an immune response, proliferation,and the like. Stimulatory ligands are well-known in the art andencompass, inter alia, an MHC Class I molecule loaded with a peptide, ananti-CD3 antibody, a superagonist anti-CD28 antibody, and a superagonistanti-CD2 antibody.

A “stimulatory molecule,” as the term is used herein, means a moleculeon a T cell that specifically binds with a cognate stimulatory ligandpresent on an antigen presenting cell (e.g., an aAPC of the invention,among others).

“Loaded” with a peptide, as used herein, refers to presentation of anantigen in the context of an MHC molecule. “Loaded” as used herein alsomeans the binding of an antibody to an Fc binding receptor on a cell,such as CD32 and/or CD64.

A “co-stimulatory signal”, as used herein, refers to a signal, which incombination with a primary signal, such as TCR/CD3 ligation, leads to Tcell proliferation and/or upregulation or downregulation of keymolecules.

A “co-stimulatory molecule” refers to the cognate binding partner on a Tcell that specifically binds with a co-stimulatory ligand, therebymediating a co-stimulatory response by the T cell, such as, but notlimited to, proliferation. Co-stimulatory molecules include, but are notlimited to CD28, an MHC class I molecule, BTLA and a Toll ligandreceptor.

“Co-stimulatory ligand,” as the term is used herein, includes a moleculeon an antigen presenting cell (e.g., an aAPC, dendritic cell, B cell,and the like) that specifically binds a cognate co-stimulatory moleculeon a T cell, thereby providing a signal which, in addition to theprimary signal provided by, for instance, binding of a TCR/CD3 complexwith an MHC molecule loaded with peptide, mediates a T cell response,including, but not limited to, proliferation, activation,differentiation, and the like. A co-stimulatory ligand can include, butis not limited to, CD7, B7-1 (CD80), B7-2 (CD86), PD-L1, PD-L2, 4-1BBL,OX40L, inducible costimulatory ligand (ICOS-L), intercellular adhesionmolecule (ICAM), CD30L, CD40, CD70, CD83, HLA-G, MICA, MICB, HVEM,lymphotoxin beta receptor, 3/TR6, ILT3, ILT4, HVEM, an agonist orantibody that binds Toll ligand receptor and a ligand that specificallybinds with B7-H3. A co-stimulatory ligand also encompasses, inter alia,an antibody that specifically binds with a co-stimulatory moleculepresent on a T cell, such as, but not limited to, CD27, CD28, 4-1BB,OX40, CD30, CD40, PD-1, ICOS, lymphocyte function-associated antigen-1(LFA-1), CD2, CD7, LIGHT, NKG2C, B7-H3, and a ligand that specificallybinds with CD83.

sDescription

The present invention provides a method of treating among otherdiseases, Chronic Lymphocytic Leukemia (CLL) and Progressive MultifocalLeukocephalopathy (PML) or any malignancy or autoimmune disease in whichchemotherapy and/or immunotherapy results in significantimmunosuppression that raises the risk for the development of PML. Inone embodiment, the invention provides a method of usingFludarabine-Cyclophosphamide followed by adoptive transfer of CD3/CD28ex vivo costimulated T cells for treating CLL and PML.

Sources of T Cells

Prior to expansion, a source of T cells is obtained from a subject. Theterm “subject” is intended to include living organisms in which animmune response can be elicited (e.g., mammals). Examples of subjectsinclude humans, dogs, cats, mice, rats, and transgenic species thereof.T cells can be obtained from a number of sources, including peripheralblood mononuclear cells, bone marrow, lymph node tissue, cord blood,thymus tissue, tissue from a site of infection, ascites, pleuraleffusion, spleen tissue, and tumors. In certain embodiments of thepresent invention, any number of T cell lines available in the art, maybe used. In certain embodiments of the present invention, T cells can beobtained from a unit of blood collected from a subject using any numberof techniques known to the skilled artisan, such as ficoll separation.In one preferred embodiment, cells from the circulating blood of anindividual are obtained by apheresis or leukapheresis. The apheresisproduct typically contains lymphocytes, including T cells, monocytes,granulocytes, B cells, other nucleated white blood cells, red bloodcells, and platelets. In one embodiment, the cells collected byapheresis may be washed to remove the plasma fraction and to place thecells in an appropriate buffer or media for subsequent processing steps.In one embodiment of the invention, the cells are washed with phosphatebuffered saline (PBS). In an alternative embodiment, the wash solutionlacks calcium and may lack magnesium or may lack many if not alldivalent cations. Again, surprisingly, initial activation steps in theabsence of calcium lead to magnified activation. As those of ordinaryskill in the art would readily appreciate a washing step may beaccomplished by methods known to those in the art, such as by using asemi-automated “flow-through” centrifuge (for example, the Cobe 2991cell processor, the Baxter CytoMate, or the Haemonetics Cell Saver 5)according to the manufacturer's instructions. After washing, the cellsmay be resuspended in a variety of biocompatible buffers, such as, forexample, Ca-free, Mg-free PBS, PlasmaLyte A, or other saline solutionwith or without buffer. Alternatively, the undesirable components of theapheresis sample may be removed and the cells directly resuspended inculture media.

In another embodiment, T cells are isolated from peripheral bloodlymphocytes by lysing the red blood cells and depleting the monocytes,for example, by centrifugation through a PERCOLL gradient or bycounterflow centrifugal elutriation. A specific subpopulation of Tcells, such as CD28⁺, CD4⁺, CD8⁺, CD45RA⁺, and CD45RO⁺ T cells, can befurther isolated by positive or negative selection techniques. Forexample, in one embodiment, T cells are isolated by incubation withanti-CD3/anti-CD28 (i.e., 3×28)-conjugated beads, such as DYNABEADS®M-450 CD3/CD28 T, for a time period sufficient for positive selection ofthe desired T cells. In one embodiment, the time period is about 30minutes. In a further embodiment, the time period ranges from 30 minutesto 36 hours or longer and all integer values there between. In a furtherembodiment, the time period is at least 1, 2, 3, 4, 5, or 6 hours. Inyet another preferred embodiment, the time period is 10 to 24 hours. Inone preferred embodiment, the incubation time period is 24 hours. Forisolation of T cells from patients with leukemia, use of longerincubation times, such as 24 hours, can increase cell yield. Longerincubation times may be used to isolate T cells in any situation wherethere are few T cells as compared to other cell types, such in isolatingtumor infiltrating lymphocytes (TIL) from tumor tissue or fromimmunocompromised individuals. Further, use of longer incubation timescan increase the efficiency of capture of CD8+ T cells. Thus, by simplyshortening or lengthening the time T cells are allowed to bind to theCD3/CD28 beads and/or by increasing or decreasing the ratio of beads toT cells (as described further herein), subpopulations of T cells can bepreferentially selected for or against at culture initiation or at othertime points during the process. Additionally, by increasing ordecreasing the ratio of anti-CD3 and/or anti-CD28 antibodies on thebeads or other surface, subpopulations of T cells can be preferentiallyselected for or against at culture initiation or at other desired timepoints. The skilled artisan would recognize that multiple rounds ofselection can also be used in the context of this invention. In certainembodiments, it may be desirable to perform the selection procedure anduse the “unselected” cells in the activation and expansion process.“Unselected” cells can also be subjected to further rounds of selection.

Enrichment of a T cell population by negative selection can beaccomplished with a combination of antibodies directed to surfacemarkers unique to the negatively selected cells. One method is cellsorting and/or selection via negative magnetic immunoadherence or flowcytometry that uses a cocktail of monoclonal antibodies directed to cellsurface markers present on the cells negatively selected. For example,to enrich for CD4⁺ cells by negative selection, a monoclonal antibodycocktail typically includes antibodies to CD14, CD20, CD11b, CD16,HLA-DR, and CD8. In certain embodiments, it may be desirable to enrichfor or positively select for regulatory T cells which typically expressCD4⁺, CD25⁺, CD62L^(hi), GITR⁺, and FoxP3⁺. Alternatively, in certainembodiments, T regulatory cells are depleted by anti-C25 conjugatedbeads or other similar method of selection.

For isolation of a desired population of cells by positive or negativeselection, the concentration of cells and surface (e.g., particles suchas beads) can be varied. In certain embodiments, it may be desirable tosignificantly decrease the volume in which beads and cells are mixedtogether (i.e., increase the concentration of cells), to ensure maximumcontact of cells and beads. For example, in one embodiment, aconcentration of 2 billion cells/ml is used. In one embodiment, aconcentration of 1 billion cells/ml is used. In a further embodiment,greater than 100 million cells/ml is used. In a further embodiment, aconcentration of cells of 10, 15, 20, 25, 30, 35, 40, 45, or 50 millioncells/ml is used. In yet another embodiment, a concentration of cellsfrom 75, 80, 85, 90, 95, or 100 million cells/ml is used. In furtherembodiments, concentrations of 125 or 150 million cells/ml can be used.Using high concentrations can result in increased cell yield, cellactivation, and cell expansion. Further, use of high cell concentrationsallows more efficient capture of cells that may weakly express targetantigens of interest, such as CD28-negative T cells, or from sampleswhere there are many tumor cells present (i.e., leukemic blood, tumortissue, etc.). Such populations of cells may have therapeutic value andwould be desirable to obtain. For example, using high concentration ofcells allows more efficient selection of CD8⁺ T cells that normally haveweaker CD28 expression.

In a related embodiment, it may be desirable to use lower concentrationsof cells. By significantly diluting the mixture of T cells and surface(e.g., particles such as beads), interactions between the particles andcells is minimized. This selects for cells that express high amounts ofdesired antigens to be bound to the particles. For example, CD4⁺ T cellsexpress higher levels of CD28 and are more efficiently captured thanCD8⁺ T cells in dilute concentrations. In one embodiment, theconcentration of cells used is 5×10⁶/ml. In other embodiments, theconcentration used can be from about 1×10⁵/ml to 1×10⁶/ml, and anyinteger value in between.

In other embodiments, the cells may be incubated on a rotator forvarying lengths of time at varying speeds at either 2-10° C. or at roomtemperature.

If desired or necessary, monocyte populations (i.e., CD14⁺ cells) may bedepleted from blood preparations prior to ex vivo expansion by a varietyof methodologies, including anti-CD14 coated beads or columns, orutilization of the phagocytotic activity of these cells to facilitateremoval, or by the use of counterflow centrifugal elutriation.Accordingly, in one embodiment, the invention uses paramagneticparticles of a size sufficient to be engulfed by phagocytotic monocytes.In certain embodiments, the paramagnetic particles are commerciallyavailable beads, for example, those produced by Dynal AS under the tradename Dynabeads™. Exemplary Dynabeads in this regard are M-280, M-450,and M-500. In one aspect, other non-specific cells are removed bycoating the paramagnetic particles with “irrelevant” proteins (e.g.,serum proteins or antibodies). Irrelevant proteins and antibodiesinclude those proteins and antibodies or fragments thereof that do notspecifically target the T cells to be expanded. In certain embodimentsthe irrelevant beads include beads coated with sheep anti-mouseantibodies, goat anti-mouse antibodies, and human serum albumin.

In brief, such depletion of monocytes is performed by preincubating PBMCisolated from whole blood or apheresed peripheral blood with one or morevarieties of irrelevant or non-antibody coupled paramagnetic particlesat any amount that allows for removal of monocytes (approximately a 20:1bead:cell ratio) for about 30 minutes to 2 hours at 22 to 37 degrees C.,followed by magnetic removal of cells which have attached to or engulfedthe paramagnetic particles. Such separation can be performed usingstandard methods available in the art. For example, any magneticseparation methodology may be used including a variety of which arecommercially available, (e.g., DYNAL® Magnetic Particle Concentrator(DYNAL MPC®)). Assurance of requisite depletion can be monitored by avariety of methodologies known to those of ordinary skill in the art,including flow cytometric analysis of CD14 positive cells, before andafter said depletion.

T cells for stimulation can also be frozen after the washing step, whichdoes not require the monocyte-removal step. Wishing not to be bound bytheory, the freeze and subsequent thaw step provides a more uniformproduct by removing granulocytes and to some extent monocytes in thecell population. After the washing step that removes plasma andplatelets, the cells may be suspended in a freezing solution. While manyfreezing solutions and parameters are known in the art and will beuseful in this context, one method involves using PBS containing 20%DMSO and 8% human serum albumin, or culture media containing 10% Dextran40 and 5% Dextrose, 20% Human Serum Albumin and 7.5% DMSO, or 31.25%Plasmalyte-A, 31.25% Dextrose 5%, 0.45% NaCl, 10% Dextran 40 and 5%Dextrose, 20% Human Serum Albumin, and 7.5% DMSO or other suitable cellfreezing media containing for example, Hespan and PlasmaLyte A, thecells then are frozen to −80° C. at a rate of 1° per minute and storedin the vapor phase of a liquid nitrogen storage tank. Other methods ofcontrolled freezing may be used as well as uncontrolled freezingimmediately at −20° C. or in liquid nitrogen.

In certain embodiments, cryopreserved cells are thawed and washed asdescribed herein and allowed to rest for one hour at room temperatureprior to activation using the methods of the present invention.

Also contemplated in the context of the invention is the collection ofblood samples or leukapheresis product from a subject at a time periodprior to when the expanded cells as described herein might be needed. Assuch, the source of the cells to be expanded can be collected at anytime point necessary, and desired cells, such as T cells, isolated andfrozen for later use in T cell therapy for any number of diseases orconditions that would benefit from T cell therapy, such as thosedescribed herein. In one embodiment a blood sample or a leukapheresis istaken from a generally healthy subject. In certain embodiments, a bloodsample or a leukapheresis is taken from a generally healthy subject whois at risk of developing a disease, but who has not yet developed adisease, and the cells of interest are isolated and frozen for lateruse. In certain embodiments, the T cells may be expanded, frozen, andused at a later time. In certain embodiments, samples are collected froma patient shortly after diagnosis of a particular disease as describedherein but prior to any treatments. In a further embodiment, the cellsare isolated from a blood sample or a leukapheresis from a subject priorto any number of relevant treatment modalities, including but notlimited to treatment with agents such as natalizumab, efalizumab,antiviral agents, chemotherapy, radiation, immunosuppressive agents,such as cyclosporin, azathioprine, methotrexate, mycophenolate, andFK506, antibodies, or other immunoablative agents such as CAMPATH,anti-CD3 antibodies, cytoxin, fludaribine, cyclosporin, FK506,rapamycin, mycophenolic acid, steroids, FR901228, and irradiation. Thesedrugs inhibit either the calcium dependent phosphatase calcineurin(cyclosporine and FK506) or inhibit the p70S6 kinase that is importantfor growth factor induced signaling (rapamycin). (Liu et al., Cell66:807-815, 1991; Henderson et al., Immun. 73:316-321, 1991; Bierer etal., Curr. Opin. Immun. 5:763-773, 1993; Isoniemi (supra)). In a furtherembodiment, the cells are isolated for a patient and frozen for lateruse in conjunction with (e.g., before, simultaneously or following) bonemarrow or stem cell transplantation, T cell ablative therapy usingeither chemotherapy agents such as, fludarabine, external-beam radiationtherapy (XRT), cyclophosphamide, or antibodies such as OKT3 or CAMPATH.In another embodiment, the cells are isolated prior to and can be frozenfor later use for treatment following B-cell ablative therapy such asagents that react with CD20, e.g., Rituxan.

In a further embodiment of the present invention, T cells are obtainedfrom a patient directly following treatment. In this regard, it has beenobserved that following certain cancer treatments, in particulartreatments with drugs that damage the immune system, shortly aftertreatment during the period when patients would normally be recoveringfrom the treatment, the quality of T cells obtained may be optimal orimproved for their ability to expand ex vivo. Likewise, following exvivo manipulation using the methods described herein, these cells may bein a preferred state for enhanced engraftment and in vivo expansion.Thus, it is contemplated within the context of the present invention tocollect blood cells, including T cells, dendritic cells, or other cellsof the hematopoetic lineage, during this recovery phase. Further, incertain embodiments, mobilization (for example, mobilization withGM-CSF) and conditioning regimens can be used to create a condition in asubject wherein repopulation, recirculation, regeneration, and/orexpansion of particular cell types is favored, especially during adefined window of time following therapy. Illustrative cell typesinclude T cells, B cells, dendritic cells, and other cells of the immunesystem.

Activation and Expansion of T Cells

T cells are activated and expanded generally using methods as described,for example, in U.S. Pat. Nos. 6,352,694; 6,534,055; 6,905,680;6,692,964; 5,858,358; 6,887,466; 6,905,681; 7,144,575; 7,067,318;7,172,869; 7,232,566; 7,175,843; 5,883,223; 6,905,874; 6,797,514;6,867,041; and U.S. Patent Application Publication No. 20060121005.

Generally, the T cells of the invention are expanded by contact with asurface having attached thereto an agent that stimulates a CD3/TCRcomplex associated signal and a ligand that stimulates a co-stimulatorymolecule on the surface of the T cells. In particular, T cellpopulations may be stimulated as described herein, such as by contactwith an anti-CD3 antibody, or antigen-binding fragment thereof, or ananti-CD2 antibody immobilized on a surface, or by contact with a proteinkinase C activator (e.g., bryostatin) in conjunction with a calciumionophore. For co-stimulation of an accessory molecule on the surface ofthe T cells, a ligand that binds the accessory molecule is used. Forexample, a population of T cells can be contacted with an anti-CD3antibody and an anti-CD28 antibody, under conditions appropriate forstimulating proliferation of the T cells. To stimulate proliferation ofeither CD4⁺ T cells or CD8⁺ T cells, an anti-CD3 antibody and ananti-CD28 antibody. Examples of an anti-CD28 antibody include 9.3, B-T3,XR-CD28 (Diaclone, Besancon, France) can be used as can other methodscommonly known in the art (Berg et al., Transplant Proc.30(8):3975-3977, 1998; Haanen et al., J. Exp. Med. 190(9):13191328,1999; Garland et al., J. Immunol Meth. 227(1-2):53-63, 1999).

In certain embodiments, the primary stimulatory signal and theco-stimulatory signal for the T cell may be provided by differentprotocols. For example, the agents providing each signal may be insolution or coupled to a surface. When coupled to a surface, the agentsmay be coupled to the same surface (i.e., in “cis” formation) or toseparate surfaces (i.e., in “trans” formation). Alternatively, one agentmay be coupled to a surface and the other agent in solution. In oneembodiment, the agent providing the co-stimulatory signal is bound to acell surface and the agent providing the primary activation signal is insolution or coupled to a surface. In certain embodiments, both agentscan be in solution. In another embodiment, the agents may be in solubleform, and then cross-linked to a surface, such as a cell expressing Fcreceptors or an antibody or other binding agent which will bind to theagents. In this regard, see for example, U.S. Patent ApplicationPublication Nos. 20040101519 and 20060034810 for artificial APCs thatare contemplated for use in activating and expanding T cells in thepresent invention.

The invention encompasses an aAPC wherein the co-stimulatory ligand is acognate binding partner that specifically binds with a co-stimulatorymolecule, as well as where the ligand is an antibody that specificallybinds with a costimulatory molecule, and any combination thereof, suchthat a single aAPC can comprise both nucleic acids encodingcostimulatory ligands and/or antibodies specific for costimulatorymolecules present on the T cell, and any combination thereof. Theextensive disclosure regarding aAPCs provided in WO 03/057171 andUS2003/0147869 is incorporated by reference as if set forth in itsentirety herein.

In one embodiment, the two agents are immobilized on beads, either onthe same bead, i.e., “cis,” or to separate beads, i.e., “trans.” By wayof example, the agent providing the primary activation signal is ananti-CD3 antibody or an antigen-binding fragment thereof and the agentproviding the co-stimulatory signal is an anti-CD28 antibody orantigen-binding fragment thereof and both agents are co-immobilized tothe same bead in equivalent molecular amounts. In one embodiment, a 1:1ratio of each antibody bound to the beads for CD4⁺ T cell expansion andT cell growth is used. In certain aspects of the present invention, aratio of anti CD3:CD28 antibodies bound to the beads is used such thatan increase in T cell expansion is observed as compared to the expansionobserved using a ratio of 1:1. In one particular embodiment an increaseof from about 0.5 to about 3 fold is observed as compared to theexpansion observed using a ratio of 1:1. In one embodiment, the ratio ofCD3:CD28 antibody bound to the beads ranges from 100:1 to 1:100 and allinteger values there between. In one aspect of the present invention,more anti-CD28 antibody is bound to the particles than anti-CD3antibody, i.e., the ratio of CD3:CD28 is less than one. In certainembodiments of the invention, the ratio of anti CD28 antibody to antiCD3 antibody bound to the beads is greater than 2:1. In one particularembodiment, a 1:100 CD3:CD28 ratio of antibody bound to beads is used.In another embodiment, a 1:75 CD3:CD28 ratio of antibody bound to beadsis used. In a further embodiment, a 1:50 CD3:CD28 ratio of antibodybound to beads is used. In another embodiment, a 1:30 CD3:CD28 ratio ofantibody bound to beads is used. In one preferred embodiment, a 1:10CD3:CD28 ratio of antibody bound to beads is used. In anotherembodiment, a 1:3 CD3:CD28 ratio of antibody bound to the beads is used.In yet another embodiment, a 3:1 CD3:CD28 ratio of antibody bound to thebeads is used.

Ratios of particles to cells from 1:500 to 500:1 and any integer valuesin between may be used to stimulate T cells or other target cells. Asthose of ordinary skill in the art can readily appreciate, the ratio ofparticle to cells may dependant on particle size relative to the targetcell. For example, small sized beads could only bind a few cells, whilelarger beads could bind many. In certain embodiments the ratio of cellsto particles ranges from 1:100 to 100:1 and any integer valuesin-between and in further embodiments the ratio comprises 1:9 to 9:1 andany integer values in between, can also be used to stimulate T cells.The ratio of anti-CD3- and anti-CD28-coupled particles to T cells thatresult in T cell stimulation can vary as noted above, however certainpreferred values include 1:100, 1:50, 1:40, 1:30, 1:20, 1:10, 1:9, 1:8,1:7, 1:6, 1:5, 1:4, 1:3, 1:2, 1:1, 2:1, 3:1, 4:1, 5:1, 6:1, 7:1, 8:1,9:1, 10:1, and 15:1 with one preferred ratio being at least 1:1particles per T cell. In one embodiment, a ratio of particles to cellsof 1:1 or less is used. In one particular embodiment, a preferredparticle: cell ratio is 1:5. In further embodiments, the ratio ofparticles to cells can be varied depending on the day of stimulation.For example, in one embodiment, the ratio of particles to cells is from1:1 to 10:1 on the first day and additional particles are added to thecells every day or every other day thereafter for up to 10 days, atfinal ratios of from 1:1 to 1:10 (based on cell counts on the day ofaddition). In one particular embodiment, the ratio of particles to cellsis 1:1 on the first day of stimulation and adjusted to 1:5 on the thirdand fifth days of stimulation. In another embodiment, particles areadded on a daily or every other day basis to a final ratio of 1:1 on thefirst day, and 1:5 on the third and fifth days of stimulation. Inanother embodiment, the ratio of particles to cells is 2:1 on the firstday of stimulation and adjusted to 1:10 on the third and fifth days ofstimulation. In another embodiment, particles are added on a daily orevery other day basis to a final ratio of 1:1 on the first day, and 1:10on the third and fifth days of stimulation. One of skill in the art willappreciate that a variety of other ratios may be suitable for use in thepresent invention. In particular, ratios will vary depending on particlesize and on cell size and type.

Using certain methodologies it may be advantageous to maintain long-termstimulation of a population of T cells following the initial activationand stimulation, by separating the T cells from the stimulus after aperiod of about 7 to about 14 days. The rate of T cell proliferation ismonitored periodically (e.g., daily) by, for example, examining the sizeor measuring the volume of the T cells, such as with a Coulter Counter.In this regard, a resting T cell has a mean diameter of about 6.8microns, and upon initial activation and stimulation, in the presence ofthe stimulating ligand, the T cell mean diameter will increase to over12 microns by day 4 and begin to decrease by about day 6. When the meanT cell diameter decreases to approximately 8 microns, the T cells may bereactivated and re-stimulated to induce further proliferation of the Tcells. Alternatively, the rate of T cell proliferation and time for Tcell re-stimulation can be monitored by assaying for the presence ofcell surface molecules, such as, CD154, CD54, CD25, CD137, CD134, whichare induced on activated T cells.

In one embodiment, T cell stimulation is performed with anti-CD3 andanti-CD28 antibodies co-immobilized on beads (3×28 beads), for a periodof time sufficient for the cells to return to a quiescent state (low orno proliferation) (approximately 8-14 days after initial stimulation).The stimulation signal is then removed from the cells and the cells arewashed and infused back into the patient. The cells at the end of thestimulation phase are rendered “super-inducible” by the methods of thepresent invention, as demonstrated by their ability to respond toantigens and the ability of these cells to demonstrate a memory-likephenotype, as is evidence by the examples. Accordingly, uponre-stimulation either exogenously or by an antigen in vivo afterinfusion, the activated T cells demonstrate a robust responsecharacterized by unique phenotypic properties, such as sustained CD154expression and increased cytokine production.

In further embodiments of the present invention, the cells, such as Tcells, are combined with agent-coated beads, the beads and the cells aresubsequently separated, and then the cells are cultured. In analternative embodiment, prior to culture, the agent-coated beads andcells are not separated but are cultured together. In a furtherembodiment, the beads and cells are first concentrated by application ofa force, such as a magnetic force, resulting in increased ligation ofcell surface markers, thereby inducing cell stimulation.

By way of example, cell surface proteins may be ligated by allowingparamagnetic beads to which anti-CD3 and anti-CD28 are attached (3×28beads) to contact the T cells. In one embodiment the cells (for example,10⁴ to 10⁹ T cells) and beads (for example, DYNABEADS® M-450 CD3/CD28 Tparamagnetic beads at a ratio of 1:1) are combined in a buffer,preferably PBS (without divalent cations such as, calcium andmagnesium). Again, those of ordinary skill in the art can readilyappreciate any cell concentration may be used. For example, the targetcell may be very rare in the sample and comprise only 0.01% of thesample or the entire sample (i.e., 100%) may comprise the target cell ofinterest. Accordingly, any cell number is within the context of thepresent invention. In certain embodiments, it may be desirable tosignificantly decrease the volume in which particles and cells are mixedtogether (i.e., increase the concentration of cells), to ensure maximumcontact of cells and particles. For example, in one embodiment, aconcentration of about 2 billion cells/ml is used. In anotherembodiment, greater than 100 million cells/ml is used. In a furtherembodiment, a concentration of cells of 10, 15, 20, 25, 30, 35, 40, 45,or 50 million cells/ml is used. In yet another embodiment, aconcentration of cells from 75, 80, 85, 90, 95, or 100 million cells/mlis used. In further embodiments, concentrations of 125 or 150 millioncells/ml can be used. Using high concentrations can result in increasedcell yield, cell activation, and cell expansion. Further, use of highcell concentrations allows more efficient capture of cells that mayweakly express target antigens of interest, such as CD28-negative Tcells. Such populations of cells may have therapeutic value and would bedesirable to obtain in certain embodiments. For example, using highconcentration of cells allows more efficient selection of CD8+ T cellsthat normally have weaker CD28 expression.

In a related embodiment, it may be desirable to use lower concentrationsof cells. By significantly diluting the mixture of T cells andparticles, interactions between particles and cells is minimized. Thisselects for cells that express high amounts of desired antigens to bebound to the particles. For example, CD4+ T cells express higher levelsof CD28 and are more efficiently captured and stimulated than CD8+ Tcells in dilute concentrations. In one embodiment, the concentration ofcells used is about 5×10⁶/ml. In other embodiments, the concentrationused can be from about 1×10⁵/ml to about 1×10⁶/ml, and any integer valuein between.

The buffer that the cells are suspended in may be any that isappropriate for the particular cell type. When utilizing certain celltypes the buffer may contain other components, e.g., 0.5-10% serum,necessary to maintain cell integrity during the process. In anotherembodiment, the cells and beads may be combined in cell culture media.The cells and beads may be mixed, for example, by rotation, agitation orany means for mixing, for a period of time ranging from one minute toseveral hours. The container of beads and cells is then concentrated bya force, such as placing in a magnetic field. Media and unbound cellsare removed and the cells attached to the beads are washed, for example,by pumping via a peristaltic pump, and then resuspended in mediaappropriate for cell culture.

In one embodiment of the present invention, the mixture may be culturedfor several hours (about 3 hours) to about 14 days or any hourly integervalue in between. In another embodiment, the mixture may be cultured for21 days. In one embodiment of the invention the beads and the T cellsare cultured together for about eight days. In another embodiment, thebeads and T cells are cultured together for 2-3 days. Several cycles ofstimulation may also be desired such that culture time of T cells can be60 days or more. Conditions appropriate for T cell culture include anappropriate media (e.g., Minimal Essential Media or RPMI Media 1640 or,X-vivo 15, (Lonza)) that may contain factors necessary for proliferationand viability, including serum (e.g., fetal bovine or human serum),interleukin-2 (IL-2), insulin, IFN-γ, IL-4, IL-7, GM-CSF, IL-10, IL-12,IL-15, TGFβ, and TNF-α. or any other additives for the growth of cellsknown to the skilled artisan. Other additives for the growth of cellsinclude, but are not limited to, surfactant, plasmanate, and reducingagents such as N-acetyl-cysteine and 2-mercaptoethanol. Media caninclude RPMI 1640, AIM-V, DMEM, MEM, α-MEM, F-12, X-Vivo 15, and X-Vivo20, Optimizer, with added amino acids, sodium pyruvate, and vitamins,either serum-free or supplemented with an appropriate amount of serum(or plasma) or a defined set of hormones, and/or an amount ofcytokine(s) sufficient for the growth and expansion of T cells.Antibiotics, e.g., penicillin and streptomycin, are included only inexperimental cultures, not in cultures of cells that are to be infusedinto a subject. The target cells are maintained under conditionsnecessary to support growth, for example, an appropriate temperature(e.g., 37° C.) and atmosphere (e.g., air plus 5% CO₂).

When using a magnetic field as the concentrating force the magneticfield strength applied to the cells prior to cell culture may be betweenthe range of 200 gauss to 12,000 gauss on the magnetic surface. Theshape and size of the magnet may be adapted to the size and shape of themixing or cell culture vessels or to any other parameter thatfacilitates or increases cell to cell contact and concentration of thecells. The magnetic force may be diffused by placing a material thatacts as a buffer or spacer between the magnet and the paramagnetic beadscontained within the mixture with cells. A strong magnetic force isgenerally considered to be at least 7500 gauss at the surface, whereas aweak magnetic force is considered to be in the range of 2000-2500 gaussat the surface. The approximate magnetic force applied by a magnet on aparamagnetic bead depends upon the volume of the paramagnetic bead andthe magnetic field strength according to the following formula:

F _(mag)=(v)(Ψ)(B)(dB/dx)

where F_(mag) equals the magnetic force, v equals the volume of theparamagnetic bead, Ψ equals the magnetic susceptibility of aparamagnetic bead (a value provided by the manufacturer), B equals themagnetic field strength, and (dB/dx) equals the field strength gradient.One of skill in the art will appreciate that the factors on theright-hand side of the equation can be obtained or measured, allowingthe magnetic force applied to be calculated.

Cells stimulated by the methods of the present invention are activatedas shown by the induction of signal transduction, expression of cellsurface markers and/or proliferation. One such marker appropriate for Tcells is CD154 which is an important immunomodulating molecule. Theexpression of CD154 is extremely beneficial in amplifying the immuneresponse. CD154 interacts with the CD40 molecule expressed on many Bcells, dendritic cells, monocytes, and some endothelial cells.Accordingly, this unexpected and surprising increase in CD154 expressionis likely to lead to more efficacious T cell compositions. Stimulationof CD3⁺ cells as described herein provides T cells that express a 1.1 to20-fold increases in the levels of certain cell surface markers such asCD154 expression on days 1, 2, 3, or 4 following stimulation. (See e.g.,US Patent Application Publication 2006-0121005). Expression of anothercell surface marker, CD25, also was greater on T cells afterconcentration and stimulation than on cells prior to culture or cellsstimulated by other methods.

The agent/ligand-coated surfaces, such as, beads may be separated fromthe cells prior to culture, at any point during culture, or at thetermination of culture. In addition, the agent-coated surfaces ligatedto the target cells may be separated from the non-binding cells prior toculture or the other cells may remain in culture as well. In oneembodiment, prior to culture, the agent-coated beads and target cellsare not separated but are cultured together. In a further embodiment,the beads and target cells are first concentrated by application of aforce, resulting in cell surface protein ligation, thereby inducingstimulation and subsequent activation.

Also contemplated by this invention, are other means to increase theconcentration of the target cells, for example, a T cell fraction boundto a surface coated with primary and secondary stimulatory molecules. Inaddition to application of a magnetic force, other forces greater thangravitational force may be applied, for example, but not limited to,centrifugal force, transmembrane pressure, and a hydraulic force.Concentration may also be accomplished by filtration.

One of skill in the art will readily appreciate that contact between theagent-coated beads and the cells to be stimulated can be increased byconcentration using other forces. Accordingly, any means forconcentrating cells with cell surface protein binding ligands will besufficient as long as the concentration brings together cells and agentsin a manner that exceeds gravity or diffusion.

It should be understood that in various embodiments the agent-coatedsurface may be a particle, such as a bead which is mixed with the cellsand concentrated in a small volume in a magnetic field, thus drawing allthe particles and particle bound cells into a defined and concentratedarea. In certain embodiments, the agent-coated surface may be drawntogether by force within thirty seconds to four hours of being exposedto the target cells. In other embodiments the time may be from 1 minuteto 2 hours, or all integer ranges in between. Application of a force toa cell population with receptor bearing cells that is mixed with asurface to which at least one cell surface ligand is attached may inducecell receptor polarization, aggregating cell surface molecules. Thismeans for inducing cell surface polarization may enhance signalingwithin the cell by aggregating cell surface molecules that compriselipid rafts. Such aggregation can induce a signal pathway, which maylead to down-regulation or suppression of a cellular event.Alternatively, the aggregation of cell surface molecules may lead toup-regulation or activation of a cellular event.

A cellular event may include, for example, receptor-mediated signaltransduction that induces or suppresses a particular pathway, includingan apoptotic pathway, or induces phosphorylation of proteins, orstimulates or suppresses growth signals. In one embodiment, the cellsmay be lymphocytes, particularly a T cell, and the cell surface ligandmay be an anti-CD3 antibody attached to a surface, for example, aparticle. The particle may be a paramagnetic bead and the force applieda magnetic force. Application of a magnetic force to a mixture of thelymphocytes and anti-CD3-coated surface of the paramagnetic bead maycause the CD3 receptors of the T cell to polarize more quickly thanwould occur in the absence of an external force. This method ofstimulating the T cell promotes more rapid activation of the T cellimmune response pathways and proliferation of cells.

In one embodiment of the present invention, bead:cell ratios can betailored to obtain a desired T cell phenotype. In one particularembodiment, bead:cell ratios can be varied to selectively expand ordelete antigen-specific (memory) T cells. In one embodiment, theparticular bead:cell ratio used selectively deletes antigen-specific Tcells. In a further embodiment, the particular bead:cell ratio usedselectively expands antigen-specific T cells. The skilled artisan wouldreadily appreciate that any ratio can be used as long as the desiredexpansion or deletion of antigen-specific T cells occurs. Therefore, thecompositions and methods described herein can be used to expand specificpopulations of T cells, or to delete specific populations of T cells,for use in any variety of immunotherapeutic settings described herein.

In another embodiment, the time of exposure to stimulatory agents suchas anti-CD3/anti-CD28 (i.e., 3×28)-coated beads may be modified ortailored to obtain a desired T cell phenotype. Alternatively, a desiredpopulation of T cells can be selected using any number of selectiontechniques, prior to stimulation. One may desire a greater population ofhelper T cells (T_(H)), typically CD4⁺ as opposed to CD8⁺ cytotoxic orregulatory T cells, because an expansion of T_(H) cells could improve orrestore overall immune responsiveness. While many specific immuneresponses are mediated by CD8⁺ antigen-specific T cells, which candirectly lyse or kill target cells, most immune responses require thehelp of CD4⁺ T cells, which express important immune-regulatorymolecules, such as GM-CSF, CD40L, and IL-2, for example. WhereCD4-mediated help if preferred, a method, such as that described herein,which preserves or enhances the CD4:CD8 ratio could be of significantbenefit. Increased numbers of CD4⁺ T cells can increase the amount ofcell-expressed CD40L introduced into patients, potentially improvingtarget cell visibility (improved APC function). Similar effects can beseen by increasing the number of infused cells expressing GM-CSF, orIL-2, all of which are expressed predominantly by CD4⁺ T cells.Alternatively, in situations where CD4-help is needed less and increasednumbers of CD8⁺ T cells are desirous, the approaches described hereincan also be utilized, by for example, pre-selecting for CD8⁺ cells priorto stimulation and/or culture. Such situations may exist where increasedlevels of IFN-γ or increased cytolysis of a target cell is preferred. Ina further embodiment, the processes described herein can be modified ortailored to promote homing of T cells to particular sites of interest,such as lymph nodes or sites of inflammation, or to bone marrow, forexample.

Additionally, in certain embodiments, it may be desirable to negativelyselect T regulatory cells to remove them from the culture. Classically,T regulatory cells have a CD4⁺, CD25⁺, CD62L^(hi), GITR⁺, and FoxP3⁺phenotype (see for example, Woo, et al., J Immunol. 2002 May 1;168(9):4272-6; Shevach, E. M., Annu. Rev. Immunol. 2000, 18:423;Stephens, et al., Eur. J. Immunol. 2001, 31:1247; Salomon, et al.,Immunity 2000, 12:431; and Sakaguchi, et al., Immunol. Rev. 2001,182:18). In certain embodiments, regulatory T cells can also begenerated and expanded using the methods of the present invention. Theregulatory T cells can be antigen-specific and/or polyclonal. RegulatoryT cells can also be generated using art-recognized techniques asdescribed for example, in Woo, et al.; Shevach, E. M.; Stephens, et al.;Salomon, et al.; and Sakaguchi, et al.; Supra.

To effectuate isolation of different T cell populations, exposure timesto the particles may be varied. For example, in one embodiment, T cellsare isolated by incubation with 3×28 beads, such as Dynabeads M-450, fora time period sufficient for positive selection of the desired T cells.In one embodiment, the time period is about 30 minutes. In a furtherembodiment, the time period is at least 1, 2, 3, 4, 5, or 6 hours. Inyet another embodiment, the time period is 10 to 24 hours or more. Inone particular embodiment, the incubation time period is 24 hours. Forisolation of T cells from cancer patients, use of longer incubationtimes, such as 24 hours, can increase cell yield.

To effectuate isolation of different T cell populations, exposure timesto the concentration force may be varied or pulsed. For example whensuch force is a magnet, exposure to the magnet or the magnetic fieldstrength may be varied, and/or expansion times may be varied to obtainthe specific phenotype of interest. The expression of a variety ofphenotypic markers change over time; therefore, a particular time pointmay be chosen to obtain a specific population of T cells. Accordingly,depending on the cell type to be stimulated, the stimulation and/orexpansion time may be 10 weeks or less, 8 weeks or less, four weeks orless, 2 weeks or less, 10 days or less, or 8 days or less (four weeks orless includes all time ranges from 4 weeks down to 1 day (24 hours) orany value between these numbers). In some embodiments in may bedesirable to clone T cells using, for example, limiting dilution or cellsorting, wherein longer stimulation time may be necessary. In someembodiments, stimulation and expansion may be carried out for 6 days orless, 4 days or less, 2 days or less, and in other embodiments for aslittle as 24 or less hours, and preferably 4-6 hours or less (theseranges include any integer values in between). When stimulation of Tcells is carried out for shorter periods of time, the population of Tcells may not increase in number as dramatically, but the populationwill provide more robust and healthy activated T cells that can continueto proliferate in vivo and more closely resemble the natural effector Tcell pool. As the availability of T cell help is often the limitingfactor in antibody responses to protein antigens, the ability toselectively expand or selectively infuse a CD4⁺ rich population of Tcells into a subject is extremely beneficial. Further benefits of suchenriched populations are readily apparent in that activated helper Tcells that recognize antigens presented by B lymphocytes deliver twotypes of stimuli, physical contact and cytokine production, that resultin the proliferation and differentiation of B cells.

T cells that have been exposed to varied stimulation times may exhibitdifferent characteristics. For example, typical blood or apheresedperipheral blood mononuclear cell products have a helper T cellpopulation (T_(H), CD4⁺) that is greater than the cytotoxic orsuppressor T cell population (T_(C), CD8⁺). Ex vivo expansion of T cellsby stimulating CD3 and CD28 receptors produces a population of T cellsthat prior to about days 8-9 consists predominately of T_(H) cells,while after about days 8-9, the population of T cells comprises anincreasingly greater population of T_(C) cells. Accordingly, dependingon the purpose of treatment, infusing a subject with a T cell populationcomprising predominately of T_(H) cells may be advantageous. Similarly,if an antigen-specific subset of T_(C) cells has been isolated it may bebeneficial to expand this subset to a greater degree.

Further, in addition to CD4 and CD8 markers, other phenotypic markersvary significantly, but in large part, reproducibly during the course ofthe cell expansion process. Thus, such reproducibility enables theability to tailor an activated T cell product for specific purposes.

In one such example, among the important phenotypic markers thatreproducibly vary with time are the high affinity IL-2 receptor (CD25),CD40 ligand (CD154), and CD45RO (a molecule that by preferentialassociation with the TCR may increase the sensitivity of the TCR toantigen binding). As one of ordinary skill in the art readilyappreciates, such molecules are important for a variety of reasons. Forexample, CD25 constitutes an important part of the autocrine loop thatallows rapid T cell division. CD154 has been shown to play a key role instimulating maturation of the antigen-presenting dendritic cells;activating B-cells for antibody production; regulating T_(H) cellproliferation; enhancing T_(C) cell differentiation; regulating cytokinesecretion of both T_(H) cells and antigen-presenting cells; andstimulating expression of co-stimulatory ligands, including CD80, CD86,and CD154.

Cytokine and chemokine production peaks in the first few days of the exvivo expansion process. Accordingly, because cytokines are known to beimportant for mediating T cell activation and function as well as immuneresponse modulation, such cytokines are likely critical in thedevelopment of a therapeutic T cell product, that is able to undergoreactivation upon contact with an additional antigen challenge.Cytokines and chemokines important in this regard, include, but are notlimited to, IL-2, IL-4, TNF-α, and IFN-γ, MIP-1α, MIP-1β, and RANTES.Thus, by obtaining a population of T cells during the first few days ofexpansion and infusing these cells into a subject, a therapeutic benefitmay occur in which additional activation and expansion of T cells invivo occurs.

In addition to the cytokines and the markers discussed previously,expression of adhesion molecules known to be important for mediation ofT cell activation and immune response modulation also changedramatically but reproducibly over the course of the ex vivo expansionprocess. For example, CD62L is important for homing of T cells tolymphoid tissues and trafficking T cells to sites of inflammation. Undercertain circumstances of disease and injury, the presence of activated Tcells at these sites may be disadvantageous. Because down-regulation ofCD62L occurs early following activation, the T cells could be expandedfor shorter periods of time. Conversely, longer periods of time inculture would generate a T cell population with higher levels of CD62Land thus a higher ability to target the activated T cells to these sitesunder other preferred conditions.

Another example of a polypeptide whose expression varies over time isCCR7. Naive T cells may also be distinguished by a relatively high levelof expression of the chemokine receptor, CCR7 (CCR7^(hi)) as compared tothe level of expression observed for non-naive T cells (see, e.g.,McFarland et al., PNAS, Vol. 97(8), pp. 4215-4220 (2000); Ishimaru etal., Nature Immunol., Vol. 7(7), pp. 763-772 (2006); and Kern et al.,Eur. J. Immunol., Vol. 29, pp. 2908-2915 (1999)). In contrast, memorycells, for example, may be characterized by a CD27¹′, CD44^(hi),CD45RA⁻, CD45RO⁺, CD57^(+ (or hi)), CD62L^(low), and/or CCR7^(low),phenotype (see, e.g., Kern et al., Eur. J. Immunol., Vol. 29, pp.2908-2915 (1999), and Baccala et al., J. Immunol., Vol. 174:4606-4612(2005)).

Another example of a polypeptide whose expression varies over time isCD49d, an adhesion molecule that is involved in trafficking lymphocytesfrom blood to tissues spaces at sites of inflammation. Binding of theCD49d ligand to CD49d also allows the T cell to receive co-stimulatorysignals for activation and proliferation through binding by VCAM-1 orfibronectin ligands. The expression of the adhesion molecule CD54,involved in T cell-APC and T cell-T cell interactions as well as homingto sites of inflammation, also changes over the course of expansion.Accordingly, T cells could be stimulated for selected periods of timethat coincide with the marker profile of interest and subsequentlycollected and infused. Thus, T cell populations could be tailored toexpress the markers believed to provide the most therapeutic benefit forthe indication to be treated.

With respect to T cells, the T cell populations resulting from thevarious expansion methodologies described herein may have a variety ofspecific phenotypic properties, depending on the conditions employed.Such phenotypic properties include enhanced expression of CD25, CD154,IFN-γ and GM-CSF, as well as altered expression of CD137, CD134, CD62L,and CD49d. The ability to differentially control the expression of thesemoieties may be very important. For example, higher levels of surfaceexpression of CD154 on “tailored T cells,” through contact with CD40molecules expressed on antigen-presenting cells (such as dendriticcells, monocytes, and even leukemic B cells or lymphomas), will enhanceantigen presentation and immune function. Such strategies are currentlybeing employed by various companies to ligate CD40 via antibodies orrecombinant CD40L. The approach described herein permits this samesignal to be delivered in a more physiological manner, e.g., by the Tcell. The ability to increase IFN-γ secretion by tailoring the T cellactivation process could help promote the generation of TH1-type immuneresponses, important for anti-tumor and anti-viral responses. LikeCD154, increased expression of GM-CSF can serve to enhance APC function,particularly through its effect on promoting the maturation of APCprogenitors into more functionally competent APC, such as dendriticcells. Altering the expression of CD137 and CD134 can affect a T cell'sability to resist or be susceptible to apoptotic signals. Controllingthe expression of adhesion/homing receptors, such as CD62L and/or CD49dand/or CCR7 may determine the ability of infused T cells to home tolymphoid organs, sites of infection, or tumor sites.

An additional aspect of the present invention provides a T cellpopulation or composition that has been depleted of CD8⁺ or CD4⁺ cellsprior to expansion. In one embodiment, CD8⁺ cells are depleted byantibodies directed to the CD8⁺ marker. One of ordinary skill in the artwould readily be able to identify a variety of particular methodologiesfor depleting a sample of CD8⁺ or CD4⁺ cells or conversely enriching theCD4⁺ or CD8⁺ cell content. With respect to enriching for CD4⁺ cells, oneaspect of the present invention is focused on the identification of anextremely robust CD154 expression profile upon stimulation of T cellpopulations wherein T_(C) (CD8⁺) cells have been depleted. As indicatedabove, CD154 is an important immunomodulating molecule whose expressionis extremely beneficial in amplifying the immune response. Accordinglyan increase in CD154 expression is likely to lead to more efficacious Tcell compositions.

In certain embodiments, it is desirable to activate and expandautologous antigen-specific T cells. In this regard, antigen-specific Tcells, such as JCV-specific T cells, can be expanded using one or moreproteins or epitopes thereof as antigen, such as JCV proteins orepitopes thereof (see e.g., U.S. Pat. No. 6,238,859). In someembodiments, antigen-specific T cells, such as BKV-specific T cells, canbe expanded using one or more proteins or epitopes thereof as antigen,such as BKV proteins or epitopes thereof. These antigen-specific T cellsmay be used alone or in conjunction with polyclonal autologous T cellsactivated and expanded using anti-CD3/anti-CD28 beads or aAPCs using themethods as described herein.

An additional aspect of the present invention provides a T cellpopulation or composition that has been depleted or enriched forpopulations of cells expressing a variety of markers, such as CD62L,CD45RA or CD45RO, cytokines (e.g., IL-2, IFN-γ, IL-4, IL-10), cytokinereceptors (e.g., CD25), perform, adhesion molecules (e.g. VLA-1, VLA-2,VLA-4, LPAM-1, LFA-1), and/or homing molecules (e.g., L-Selectin), priorto expansion. In one embodiment, cells expressing any of these markersare depleted or positively selected by antibodies or otherligands/binding agents directed to the marker. One of ordinary skill inthe art would readily be able to identify a variety of particularmethodologies for depleting or positively selecting for a sample ofcells expressing a desired marker.

The phenotypic properties of T cell populations of the present inventioncan be monitored by a variety of methods including standard flowcytometry methods and ELISA methods known by those skilled in the art.

In the various embodiments, one of ordinary skill in the art understandsremoval of the stimulation signal from the cells is dependent upon thetype of surface used. For example, if paramagnetic beads are used, thenmagnetic separation is the feasible option. Separation techniques aredescribed in detail by paramagnetic bead manufacturers' instructions(for example, DYNALBiotech, Oslo, Norway a unit of Invitrogen LifeTechnologies). Furthermore, filtration may be used if the surface is abead large enough to be separated from the cells. In addition, a varietyof transfusion filters are commercially available, including 20 micronand 80 micron transfusion filters (Baxter). Accordingly, so long as thebeads are larger than the mesh size of the filter, such filtration ishighly efficient. In a related embodiment, the beads may pass throughthe filter, but cells may remain, thus allowing separation. In oneparticular embodiment the biocompatible surface used degrades (i.e.,biodegradable) in culture during the exposure period.

Those of ordinary skill in the art will readily appreciate that the cellstimulation methodologies described herein may be carried out in avariety of environments (i.e., containers). For example, such containersmay be culture flasks, culture bags, or any container capable of holdingcells, preferably in a sterile environment. In one embodiment of thepresent invention a bioreactor is also useful. For example, severalmanufacturers currently make devices that can be used to grow cells andbe used in combination with the methods of the present invention. Seefor example, Celdyne Corp., Houston, Tex.; Unisyn Technologies,Hopkinton, Mass.; Synthecon, Inc., Houston, Tex.; Aastrom Biosciences,Inc., Ann Arbor, Mich.; Wave Biotech LLC, Bedminster, N.J. Further,patents covering such bioreactors include U.S. Pat. Nos. 6,096,532;5,985,653; 5,888,807; 5,190,878, which are incorporated herein byreference.

In one embodiment, the magnet used for simultaneous stimulation andconcentration of the cells of the present invention may be incorporatedinto the base rocker platform of a bioreactor device, such as “The Wave”(Wave Biotech LLC, Bedminster, N.J.). The magnet, or a magnetizableelement, may also be enclosed into a standard bioreactor vessel such asa cylindrical application unit. This built-in magnetic element may becapable of being switched on and off as desired at various points in thecell culture procedure. The integrated magnet, or magnetizable element,is positioned so as to allow a magnetic field emanating therefrom topass through the culture vessel. In certain embodiments, the magnet, ormagnetizable element, is incorporated within a wall, or alternatively,within the body of the culture vessel. In a further embodiment, thecells can be magnetically concentrated and/or activated, magneticallyseparated or isolated at a desired point during culture without the needto transfer cells to a different culture or magnetic separation unit.Use of such a built-in magnetic element can facilitate culture,stimulation and concentration, and separation processes to enableexpansion and tailoring of specific functional cell populations forimmunotherapeutic infusion into patients in cell or gene-basedtherapies. Further, this device provides an improved means for specificproduction of molecules both inside cells and their secretion to theoutside of cells.

The integrated magnetic or magnetizable device as described above can beused to either remove magnetic particles from the culture, retainingthem in the culture vessel, whilst the desired cells and/or desiredmolecules present in the culture media are removed. Alternatively, thecells and/or desired molecules may be specifically retained in theculture bag, or other suitable culture vessel, by interaction withmagnetic particles that have been coated with specific molecules asdescribed herein that bind to the desired cells and/or molecules. Thebuilt-in magnetic or magnetizable device enables the washing of cellpopulations and replacement of media in the cell culture bag bymagnetically immobilizing/concentrating cells with specific particlesand flowing media and or other solutions through the bag. This deviceeffectively eliminates the need for a separate magnetic separationdevice by providing a fully integrated system, thereby reducing processtime and manual operations for tubing connectors, reducing the number ofcontainers used in processing and reducing the likelihood ofcontamination through the number of tube and container connectionsrequired. This integrated magnetic or magnetizable device-culture systemalso reduces the volumes needed in the culture processing andformulation.

The combination of a force which induces the concentration of cells,ligation of cell surface moieties, and culturing cells in a rocking,closed system, results in a profound enhancement in activation andexpansion of these cells (see e.g., U.S. Patent Application PublicationNo. 20060121005). Accordingly, in one embodiment, a bioreactor with abase rocker platform is used, for example such as “The Wave” (WaveBiotech LLC, Bedminster, N.J.), that allows for varying rates of rockingand at a variety of different rocking angles. The skilled artisan willrecognize that any platform that allows for the appropriate motion foroptimal expansion of the cells is within the context of the presentinvention. In certain embodiments, the methods of stimulation andexpansion of the present invention provide for rocking the culturecontainer during the process of culturing at 1, 2, 3, 4, 5, 6, 7, 8, 9,10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 rocks per minute. Incertain embodiments, the methods of stimulation and expansion of thepresent invention provide for the angle of the rocking platform to beset at 1.5°, 2°, 2.5°, 3°, 3.5°, 4°, 4.5°, 5°, 5.5°, 6°, 6.5°, 7°, 7.5°,8°, 8.5°, or 9.0°.

In certain embodiments, the capacity of the bioreactor container rangesfrom about 0.1 liter to about 200 liters of medium. The skilled artisanwill readily appreciate that the volume used for culture will varydepending on the number of starting cells and on the final number ofcells desired. In particular embodiments, the cells of the presentinvention, such as T cells are seeded at an initial concentration ofabout 0.2×10⁶ cells/ml to about 5×10⁶ cells/ml, and any concentrationtherebetween. In one particular embodiment, the cells may be culturedinitially in a static environment and transferred to a bioreactor on arocking platform after 1, 2, 3, 4, 5, 6, 7, 8, or more days of culture.In a related embodiment, the entire process of stimulation, activation,and expansion takes place in a bioreactor comprising a rocking platformand an integrated magnet, as described above. Illustrative bioreactorsinclude, but are not limited to, “The Wave”.

In one particular embodiment, the cell stimulation methods of thepresent invention are carried out in a closed system, such as abioreactor, that allows for perfusion of medium at varying rates, suchas from about 0.1 ml/minute to about 10 ml/minute. Accordingly, incertain embodiments, the container of such a closed system comprises anoutlet filter, an inlet filter, and a sampling port for sterile transferto and from the closed system. In other embodiments, the container ofsuch a closed system comprises a syringe pump and control for steriletransfer to and from the closed system. Further embodiments provide fora mechanism, such as a load cell, for controlling media in-put andout-put by continuous monitoring of the weight of the bioreactorcontainer. In one embodiment the system comprises a gas manifold. Inanother embodiment, the bioreactor of the present invention comprises aCO₂ gas mix rack that supplies a mixture of ambient air and CO₂ to thebioreactor container and maintains the container at positive pressure.In another embodiment, the bioreactor of the present invention comprisesa variable heating element.

In one embodiment, media is allowed to enter the container starting onday 2, 3, 4, 5, or 6 at about 0.5 to 5.0 liters per day until thedesired final volume is achieved. In one preferred embodiment, mediaenters the container at 2 liters per day starting at day 4, until thevolume reaches 10 liters. Once desired volume is achieved, perfusion ofmedia can be initiated. In certain embodiments, perfusion of mediathrough the system is initiated on about day 2, 3, 4, 5, 6, 7, 8, 9, 10,11, or 12 of culture. In one embodiment, perfusion is initiated when thevolume is at about 0.1 liter to about 200 liters of media. In oneparticular embodiment, perfusion is initiated when the final volume isat 4, 5, 6, 7, 8, 9, 10, or 20 liters or higher volume. The rate ofperfusion can be from about 0.5 ml/minute to about 10 ml/minute. Incertain embodiments, the perfusion rate is about 1, 2, 2.5, 3, 3.5, 4,4.5, 5, 5.5, 6, 6.5, 7, 7.5, or 8.0 mls/minute.

In a further embodiment of the present invention, the cells, such as Tcells, are cultured for up to 5 days in a closed, static system and thentransferred to a closed system that comprises a rocking element to allowrocking of the culture container at varying speeds.

In certain aspects, the methodologies of the present invention providefor the expansion of cells, such as T cells, to a concentration of aboutbetween 6×10⁶ cell/ml and about 90×10⁶ cells/ml in less than about twoweeks. In particular the methodologies herein provide for the expansionof T cells to a concentration of about 10, 15, 20, 25, 30, 35, 40, 45,50, 55, 60, 65, 70, 75, 80, or 85×10⁶ cells/ml and all concentrationstherein. In certain embodiments, the cells reach a desiredconcentration, such as any of those listed above, by about day 5, 6, 7,8, 9, 10, 11, or 12 of culture. In one embodiment, the T cells expand byat least about 1.5 fold in about 24 hours from about day 4 to about day12 of culture. In one embodiment, the cells, such as T cells, expandfrom a starting number of cells of about 100×10⁶ to a total of about500×10⁹ cells in less than about two weeks. In further embodiments, theT cells expand from a starting number of cells of about 500×10⁶ to atotal of about 500×10⁹ cells in less than about two weeks. In relatedembodiments, the cells expand from a starting number of about100-500×10⁶ to a total of about 200, 300, or 400×10⁹ cells in less thanabout two weeks.

Although the antibodies used in the methods described herein can bereadily obtained from public sources, such as the ATCC, antibodies to Tcell accessory molecules and the CD3 complex can be produced by standardtechniques. Methodologies for generating antibodies for use in themethods of the invention are well-known in the art and are discussed infurther detail herein.

Agent/Ligand Immobilization on a Surface

As indicated above, the methods of the present invention preferably useagents/ligands bound to a surface. The surface may be any surfacecapable of having an agent/ligand bound thereto or integrated into andthat is biocompatible, that is, substantially non-toxic to the targetcells to be stimulated. The biocompatible surface may be biodegradableor non-biodegradable. The surface may be natural or synthetic, and asynthetic surface may be a polymer. The surface may comprise collagen,purified proteins, purified peptides, polysaccharides,glycosaminoglycans, or extracellular matrix compositions. Apolysaccharide may include for example, cellulose, agarose, dextran,chitosan, hyaluronic acid, or alginate. Other polymers may includepolyesters, polyethers, polyanhydrides, polyalkylcyanoacryllates,polyacrylamides, polyorthoesters, polyphosphazenes, polyvinylacetates,block copolymers, polypropylene, polytetrafluorethylene (PTFE), orpolyurethanes. The polymer may be lactic acid or a copolymer. Acopolymer may comprise lactic acid and glycolic acid (PLGA).Non-biodegradable surfaces may include polymers, such aspoly(dimethylsiloxane) and poly(ethylene-vinyl acetate). Biocompatiblesurfaces include for example, glass (e.g., bioglass), collagen, metal,hydroxyapatite, aluminate, bioceramic materials, hyaluronic acidpolymers, alginate, acrylic ester polymers, lactic acid polymer,glycolic acid polymer, lactic acid/glycolic acid polymer, purifiedproteins, purified peptides, or extracellular matrix compositions. Otherpolymers comprising a surface may include glass, silica, silicon,hydroxyapatite, hydrogels, collagen, acrolein, polyacrylamide,polypropylene, polystyrene, nylon, or any number of plastics orsynthetic organic polymers, or the like. The surface may comprise abiological structure, such as a liposome or a cell. In this regard, thesurface may comprise an artificial APC such as those described in U.S.Patent Application Publication Nos. 20040101519 and 20060034810. Thesurface may be in the form of a lipid, a plate, bag, pellet, fiber,mesh, or particle. A particle may include, a colloidal particle, amicrosphere, nanoparticle, a bead, or the like. In the variousembodiments, commercially available surfaces, such as beads or otherparticles, are useful (e.g., Miltenyi Particles, Miltenyi Biotec,Germany; Sepharose beads, Pharmacia Fine Chemicals, Sweden; DYNABEADS™,Dynal Inc., New York; PURABEADS™, Prometic Biosciences).

When beads are used, the bead may be of any size that effectuates targetcell stimulation. In one embodiment, beads are preferably from about 5nanometers to about 500 μm in size. Accordingly, the choice of bead sizedepends on the particular use the bead will serve. For example, if thebead is used for monocyte depletion, a small size is chosen tofacilitate monocyte ingestion (e.g., 2.8 μm and 4.5 μm in diameter orany size that may be engulfed, such as nanometer sizes); however, whenseparation of beads by filtration is desired, bead sizes of no less than50 μm are typically used. Further, when using paramagnetic beads, thebeads typically range in size from about 2.8 μm to about 500 μm and morepreferably from about 2.8 μm to about 50 μm. Lastly, one may choose touse super-paramagnetic nanoparticles which can be as small as about 10⁻⁵nm. Accordingly, as is readily apparent from the discussion above,virtually any particle size may be utilized.

An agent may be attached or coupled to, or integrated into a surface bya variety of methods known and available in the art. The agent may be anatural ligand, a protein ligand, or a synthetic ligand. The attachmentmay be covalent or noncovalent, electrostatic, or hydrophobic and may beaccomplished by a variety of attachment means, including for example,chemical, mechanical, enzymatic, electrostatic, or other means whereby aligand is capable of stimulating the cells. For example, the antibody toa ligand first may be attached to a surface, or avidin or streptavidinmay be attached to the surface for binding to a biotinylated ligand. Theantibody to the ligand may be attached to the surface via anantiidiotype antibody. Another example includes using protein A orprotein G, or other non-specific antibody binding molecules, attached tosurfaces to bind an antibody. Alternatively, the ligand may be attachedto the surface by chemical means, such as cross-linking to the surface,using commercially available cross-linking reagents (Pierce, Rockford,Ill.) or other means. In certain embodiments, the ligands are covalentlybound to the surface. Further, in one embodiment, commercially availabletosyl-activated DYNABEADS™ or DYNABEADS™ with epoxy-surface reactivegroups are incubated with the polypeptide ligand of interest accordingto the manufacturer's instructions. Briefly, such conditions typicallyinvolve incubation in a phosphate buffer from pH 4 to pH 9.5 attemperatures ranging from 4 to 37 degrees C.

In one aspect, the agent, such as certain ligands may be of singularorigin or multiple origins and may be antibodies or fragments thereofwhile in another aspect, when utilizing T cells, the co-stimulatoryligand is a B7 molecule (e.g., B7-1, B7-2). These ligands are coupled tothe surface by any of the different attachment means discussed above.The B7 molecule to be coupled to the surface may be isolated from a cellexpressing the co-stimulatory molecule, or obtained using standardrecombinant DNA technology and expression systems that allow forproduction and isolation of the co-stimulatory molecule(s) as describedherein. Fragments, mutants, or variants of a B7 molecule that retain thecapability to trigger a co-stimulatory signal in T cells when coupled tothe surface of a cell can also be used. Furthermore, one of ordinaryskill in the art will recognize that any ligand useful in the activationand induction of proliferation of a subset of T cells may also beimmobilized on beads or culture vessel surfaces or any surface. Inaddition, while covalent binding of the ligand to the surface is onepreferred methodology, adsorption or capture by a secondary monoclonalantibody may also be used. The amount of a particular ligand attached toa surface may be readily determined by flow cytometric analysis if thesurface is that of beads or determined by enzyme-linked immunosorbentassay (ELISA) if the surface is a tissue culture dish, mesh, fibers,bags, for example.

In a particular embodiment, the stimulatory form of a B7 molecule or ananti-CD28 antibody or fragment thereof is attached to the same solidphase surface as the agent that stimulates the TCR/CD3 complex, such asan anti-CD3 antibody. In an additional embodiment, the stimulatory formof a 4-1BB molecule or an anti-4-1BB antibody or fragment thereof isattached to the same solid phase surface as the agent that stimulatesthe TCR/CD3 complex, such as an anti-CD3 antibody. In addition toanti-CD3 antibodies, other antibodies that bind to receptors that mimicantigen signals may be used. For example, the beads or other surfacesmay be coated with combinations of anti-CD2 antibodies and a B7 moleculeand in particular anti-CD3 antibodies and anti-CD28 antibodies. Infurther embodiments, the surfaces may be coated with three or moreagents, such as combinations of any of the agents described herein, forexample, anti-CD3 antibodies, anti-CD28 antibodies, and anti-4-1BBantibodies.

When coupled to a surface, the agents may be coupled to the same surface(i.e., in “cis” formation) or to separate surfaces (i.e., in “trans”formation). Alternatively, one agent may be coupled to a surface and theother agent in solution. In one embodiment, the agent providing theco-stimulatory signal is bound to a cell surface and the agent providingthe primary activation signal is in solution or coupled to a surface. Ina preferred embodiment, the two agents are immobilized on beads, eitheron the same bead, i.e., “cis,” or to separate beads, i.e., “trans.” Byway of example, the agent providing the primary activation signal is ananti-CD3 antibody and the agent providing the co-stimulatory signal isan anti-CD28 antibody; and both agents are co-immobilized to the samebead in equivalent molecular amounts. In one embodiment, a 1:1 ratio ofeach antibody bound to the beads for CD4⁺ T cell expansion and T cellgrowth is used. In certain aspects of the present invention, a ratio ofanti CD3:CD28 antibodies bound to the beads is used such that anincrease in T cell expansion is observed as compared to the expansionobserved using a ratio of 1:1. In one particular embodiment an increaseof from about 0.5 to about 3 fold is observed as compared to theexpansion observed using a ratio of 1:1. In one embodiment, the ratio ofCD3:CD28 antibody bound to the beads ranges from 100:1 to 1:100 and allinteger values there between. In one aspect of the present invention,more anti-CD28 antibody is bound to the particles than anti-CD3antibody, i.e. the ratio of CD3:CD28 is less than one. In certainembodiments of the invention, the ratio of anti CD28 antibody to antiCD3 antibody bound to the beads is greater than 2:1. In one particularembodiment, a 1:100 CD3:CD28 ratio of antibody bound to beads is used.In another embodiment, a 1:75 CD3:CD28 ratio of antibody bound to beadsis used. In a further embodiment, a 1:50 CD3:CD28 ratio of antibodybound to beads is used. In another embodiment, a 1:30 CD3:CD28 ratio ofantibody bound to beads is used. In one preferred embodiment, a 1:10CD3:CD28 ratio of antibody bound to beads is used. In anotherembodiment, a 1:3 CD3:CD28 ratio of antibody bound to the beads is used.In yet another embodiment, a 3:1 CD3:CD28 ratio of antibody bound to thebeads is used.

In certain aspects of the present invention, three or more agents arecoupled to a surface. In certain embodiments, the agents may be coupledto the same surface (i.e., in “cis” formation) or to separate surfaces(i.e., in “trans” formation). Alternatively, one or more agents may becoupled to a surface and the other agent or agents may be in solution.

Agents

Agents contemplated by the present invention include protein ligands,natural ligands, and synthetic ligands. Agents that can bind to cellsurface moieties, and under certain conditions, cause ligation andaggregation that leads to signaling include, but are not limited to,lectins (for example, PHA, lentil lectins, concanavalin A), antibodies,antibody fragments, peptides, polypeptides, glycopeptides, receptors, Bcell receptor and T cell receptor ligands, extracellular matrixcomponents, steroids, hormones (for example, growth hormone,corticosteroids, prostaglandins, tetra-iodo thyronine), bacterialmoieties (such as lipopolysaccharides), mitogens, antigens (e.g., JCVproteins or antigens derived therefrom; see e.g., U.S. Pat. No.6,238,859), superantigens and their derivatives, growth factors,cytokine, viral proteins (for example, HIV gp-120), adhesion molecules(such as, L-selectin, LFA-3, CD54, LFA-1), chemokines, and smallmolecules. The agents may be isolated from natural sources such ascells, blood products, and tissues, or isolated from cells propagated invitro, or prepared recombinantly, or by other methods known to thosewith skill in the art.

In one aspect of the present invention, when it is desirous to stimulateT cells, useful agents include ligands that are capable of binding theCD3/TCR complex, CD2, and/or CD28 and initiating activation orproliferation, respectively. Accordingly, the term ligand includes thoseproteins that are the “natural” ligand for the cell surface protein,such as a B7 molecule for CD28, as well as artificial ligands such asantibodies directed to the cell surface protein. Such antibodies andfragments thereof may be produced in accordance with conventionaltechniques, such as hybridoma methods and recombinant DNA and proteinexpression techniques. Useful antibodies and fragments may be derivedfrom any species, including humans, or may be formed as chimericproteins, which employ sequences from more than one species.

Methods well known in the art may be used to generate antibodies,polyclonal antisera, or monoclonal antibodies that are specific for aligand. Antibodies also may be produced as genetically engineeredimmunoglobulins (Ig) or Ig fragments designed to have desirableproperties. For example, by way of illustration and not limitation,antibodies may include a recombinant IgG that is a chimeric fusionprotein having at least one variable (V) region domain from a firstmammalian species and at least one constant region domain from a seconddistinct mammalian species. Most commonly, a chimeric antibody hasmurine variable region sequences and human constant region sequences.Such a murine/human chimeric immunoglobulin may be “humanized” bygrafting the complementarity determining regions (CDRs), which conferbinding specificity for an antigen, derived from a murine antibody intohuman-derived V region framework regions and human-derived constantregions. Fragments of these molecules may be generated by proteolyticdigestion, or optionally, by proteolytic digestion followed by mildreduction of disulfide bonds and alkylation, or by recombinant geneticengineering techniques.

Antibodies are defined to be “immunospecific” if they specifically bindthe ligand with an affinity constant, K_(a), of greater than or equal toabout 10⁴ M⁻¹, preferably of greater than or equal to about 10⁵ M⁻¹,more preferably of greater than or equal to about 10⁶ M⁻¹, and stillmore preferably of greater than or equal to about 10⁷ M⁻¹. Affinities ofbinding partners or antibodies can be readily determined usingconventional techniques, for example, those described by Scatchard etal. (Ann. N.Y. Acad. Sci. USA 51:660, 1949) or by surface plasmonresonance (BIAcore, Biosensor, Piscataway, N.J.) See, e.g., Wolff etal., Cancer Res., 53:2560-2565, 1993).

Antibodies may generally be prepared by any of a variety of techniquesknown to those having ordinary skill in the art (See, e.g., Harlow etal., Antibodies: A Laboratory Manual, 1988, Cold Spring HarborLaboratory). In one such technique, an animal is immunized with theligand as antigen to generate polyclonal antisera. Suitable animalsinclude rabbits, sheep, goats, pigs, cattle, and may include smallermammalian species, such as, mice, rats, and hamsters.

An immunogen may be comprised of cells expressing the ligand, purifiedor partially purified ligand polypeptides or variants or fragmentsthereof, or ligand peptides. Ligand peptides may be generated byproteolytic cleavage or may be chemically synthesized. Peptides forimmunization may be selected by analyzing the primary, secondary, ortertiary structure of the ligand according to methods know to thoseskilled in the art in order to determine amino acid sequences morelikely to generate an antigenic response in a host animal (See, e.g.,Novotny, Mol. Immunol. 28:201-207, 1991; Berzoksky, Science 229:932-40,1985).

Preparation of the immunogen may include covalent coupling of the ligandpolypeptide or variant or fragment thereof, or peptide to anotherimmunogenic protein, such as, keyhole limpet hemocyanin or bovine serumalbumin. In addition, the peptide, polypeptide, or cells may beemulsified in an adjuvant (See Harlow et al., Antibodies: A LaboratoryManual, 1988 Cold Spring Harbor Laboratory). In general, after the firstinjection, animals receive one or more booster immunizations accordingto a preferable schedule for the animal species. The immune response maybe monitored by periodically bleeding the animal, separating the sera,and analyzing the sera in an immunoassay, such as an Ouchterlony assay,to assess the specific antibody titer. Once an antibody titer isestablished, the animals may be bled periodically to accumulate thepolyclonal antisera. Polyclonal antibodies that bind specifically to theligand polypeptide or peptide may then be purified from such antisera,for example, by affinity chromatography using protein A or using theligand polypeptide or peptide coupled to a suitable solid support.

Monoclonal antibodies that specifically bind ligand polypeptides orfragments or variants thereof may be prepared, for example, using thetechnique of Kohler and Milstein (Nature, 256:495-497, 1975; Eur. J.Immunol. 6:511-519, 1976) and improvements thereto. Hybridomas, whichare immortal eukaryotic cell lines, may be generated that produceantibodies having the desired specificity to a the ligand polypeptide orvariant or fragment thereof. An animal—for example, a rat, hamster, orpreferably mouse—is immunized with the ligand immunogen prepared asdescribed above. Lymphoid cells, most commonly, spleen cells, obtainedfrom an immunized animal may be immortalized by fusion with adrug-sensitized myeloma cell fusion partner, preferably one that issyngeneic with the immunized animal. The spleen cells and myeloma cellsmay be combined for a few minutes with a membrane fusion-promotingagent, such as polyethylene glycol or a nonionic detergent, and thenplated at low density on a selective medium that supports the growth ofhybridoma cells, but not myeloma cells. A preferred selection media isHAT (hypoxanthine, aminopterin, thymidine). After a sufficient time,usually about 1 to 2 weeks, colonies of cells are observed. Singlecolonies are isolated, and antibodies produced by the cells may betested for binding activity to the ligand polypeptide or variant orfragment thereof. Hybridomas producing antibody with high affinity andspecificity for the ligand antigen are preferred. Hybridomas thatproduce monoclonal antibodies that specifically bind to a ligandpolypeptide or variant or fragment thereof are contemplated by thepresent invention.

Monoclonal antibodies may be isolated from the supernatants of hybridomacultures. An alternative method for production of a murine monoclonalantibody is to inject the hybridoma cells into the peritoneal cavity ofa syngeneic mouse. The mouse produces ascites fluid containing themonoclonal antibody. Contaminants may be removed from the antibody byconventional techniques, such as chromatography, gel filtration,precipitation, or extraction.

Human monoclonal antibodies may be generated by any number oftechniques. Methods include but are not limited to, Epstein Barr Virus(EBV) transformation of human peripheral blood cells (see, U.S. Pat. No.4,464,456), in vitro immunization of human B cells (see, e.g., Boerneret al., J. Immunol. 147:86-95, 1991), fusion of spleen cells fromimmunized transgenic mice carrying human immunoglobulin genes and fusionof spleen cells from immunized transgenic mice carrying immunoglobulingenes inserted by yeast artificial chromosome (YAC) (see, e.g., U.S.Pat. No. 5,877,397; Bruggemann et al., Curr. Opin. Biotechnol. 8:455-58,1997; Jakobovits et al., Ann. N.Y. Acad. Sci. 764:525-35, 1995), orisolation from human immunoglobulin V region phage libraries.

Chimeric antibodies and humanized antibodies for use in the presentinvention may be generated. A chimeric antibody has at least oneconstant region domain derived from a first mammalian species and atleast one variable region domain derived from a second distinctmammalian species (See, e.g., Morrison et al., Proc. Natl. Acad. Sci.USA, 81:6851-55, 1984). Most commonly, a chimeric antibody may beconstructed by cloning the polynucleotide sequences that encode at leastone variable region domain derived from a non-human monoclonal antibody,such as the variable region derived from a murine, rat, or hamstermonoclonal antibody, into a vector containing sequences that encode atleast one human constant region. (See, e.g., Shin et al., MethodsEnzymol. 178:459-76, 1989; Walls et al., Nucleic Acids Res. 21:2921-29,1993). The human constant region chosen may depend upon the effectorfunctions desired for the particular antibody. Another method known inthe art for generating chimeric antibodies is homologous recombination(U.S. Pat. No. 5,482,856). Preferably, the vectors will be transfectedinto eukaryotic cells for stable expression of the chimeric antibody.

A non-human/human chimeric antibody may be further geneticallyengineered to create a “humanized” antibody. Such an antibody has aplurality of CDRs derived from an immunoglobulin of a non-humanmammalian species, at least one human variable framework region, and atleast one human immunoglobulin constant region. Humanization may yieldan antibody that has decreased binding affinity when compared with thenon-human monoclonal antibody or the chimeric antibody. Those havingskill in the art, therefore, use one or more strategies to designhumanized antibodies.

Within certain embodiments, the use of antigen-binding fragments ofantibodies may be preferred. Such fragments include Fab fragments orF(ab′)₂ fragments, which may be prepared by proteolytic digestion withpapain or pepsin, respectively. The antigen binding fragments may beseparated from the Fc fragments by affinity chromatography, for example,using immobilized protein A or immobilized ligand polypeptide or avariant or a fragment thereof Δn alternative method to generate Fabfragments includes mild reduction of F(ab′)₂ fragments followed byalkylation (See, e.g., Weir, Handbook of Experimental Immunology, 1986,Blackwell Scientific, Boston).

Non-human, human, or humanized heavy chain and light chain variableregions of any of the above described Ig molecules may be constructed assingle chain Fv (sFv) fragments (single chain antibodies). See, e.g.,Bird et al., Science 242:423-426, 1988; Huston et al., Proc. Natl. Acad.Sci. USA 85:5879-5883, 1988. Multi-functional fusion proteins may begenerated by linking polynucleotide sequences encoding an sFv in-framewith polynucleotide sequences encoding various effector proteins. Thesemethods are known in the art, and are disclosed, for example, inEP-B1-0318554, U.S. Pat. Nos. 5,132,405, 5,091,513, and 5,476,786.

An additional method for selecting antibodies that specifically bind toa ligand polypeptide or variant or fragment thereof is by phage display(See, e.g., Winter et al., Annul. Rev. Immunol. 12:433-55, 1994; Burtonet al., Adv. Immunol. 57:191-280, 1994). Human or murine immunoglobulinvariable region gene combinatorial libraries may be created in phagevectors that can be screened to select Ig fragments (Fab, Fv, sFv, ormultimers thereof) that bind specifically to a ligand polypeptide orvariant or fragment thereof (See, e.g., U.S. Pat. No. 5,223,409; Huse etal., Science 246:1275-81, 1989; Kang et al., Proc. Natl. Acad. Sci. USA88:4363-66, 1991; Hoogenboom et al., J. Molec. Biol. 227:381-388, 1992;Schlebusch et al., Hybridoma 16:47-52, 1997 and references citedtherein).

Methods of Use and Pharmaceutical Compositions

Generally, the cells activated and expanded as described herein may beutilized in the treatment and prevention of diseases that arise inindividuals who are immunocompromised. In particular, the autologousactivated and expanded T cells of the invention are used in thetreatment of PML. In certain embodiments, the cells of the invention areused in the treatment of patients at risk for developing PML, such as MSpatients taking natalizumab, psoriasis patients taking efalizumab, HIVinfected individuals, or other immunocompromised invidivuals with a riskof developing PML. Thus, the present invention provides methods for thetreatment or prevention of PML comprising administering to a subject inneed thereof, a therapeutically effective amount of the T cellsactivated and expanded using the methods described herein.

The T cell populations of the present invention may be administeredeither alone, or as a pharmaceutical composition in combination withdiluents and/or with other components such as IL-2 or other cytokines orcell populations. Briefly, pharmaceutical compositions of the presentinvention may comprise a target cell population as described herein, incombination with one or more pharmaceutically or physiologicallyacceptable carriers, diluents or excipients. Such compositions maycomprise buffers such as neutral buffered saline, phosphate bufferedsaline and the like; carbohydrates such as glucose, mannose, sucrose ordextrans, mannitol; proteins; polypeptides or amino acids such asglycine; antioxidants; chelating agents such as EDTA or glutathione;adjuvants (e.g., aluminum hydroxide); and preservatives. Compositions ofthe present invention are preferably formulated for intravenousadministration.

Pharmaceutical compositions of the present invention may be administeredin a manner appropriate to the disease to be treated (or prevented). Thequantity and frequency of administration will be determined by suchfactors as the condition of the patient, and the type and severity ofthe patient's disease, although appropriate dosages may be determined byclinical trials.

The immune response induced in a subject by administering T cellsactivated and expanded using the methods described herein, or othermethods known in the art wherein T cells are stimulated and expanded totherapeutic levels, may include cellular immune responses mediated bycytotoxic T cells, capable of killing tumor and infected cells,regulatory T cells, and helper T cell responses. Humoral immuneresponses, mediated primarily by helper T cells capable of activating Bcells thus leading to antibody production, may also be induced. Avariety of techniques may be used for analyzing the type of immuneresponses induced by the compositions of the present invention, whichare well described in the art; e.g., Coligan et al. Current Protocols inImmunology, John Wiley & Sons Inc. (1994).

When “an immunologically effective amount”, “an anti-tumor effectiveamount”, “an tumor-inhibiting effective amount”, or “therapeutic amount”is indicated, the precise amount of the compositions of the presentinvention to be administered can be determined by a physician withconsideration of individual differences in age, weight, tumor size,extent of infection or metastasis, and condition of the patient(subject). It can generally be stated that a pharmaceutical compositioncomprising the T cells described herein may be administered at a dosageof 10⁴ to 10⁹ cells/kg body weight, preferably 10⁵ to 10⁶ cells/kg bodyweight, including all integer values within those ranges. T cellcompositions may also be administered multiple times at these dosages.The cells can be administered by using infusion techniques that arecommonly known in immunotherapy (see, e.g., Rosenberg et al., New Eng.J. of Med. 319:1676, 1988). The optimal dosage and treatment regime fora particular patient can readily be determined by one skilled in the artof medicine by monitoring the patient for signs of disease and adjustingthe treatment accordingly.

Typically, in adoptive immunotherapy studies, antigen-specific T cellsare administered approximately at 2×10⁹ to 2×10¹¹ cells to the patient.(See, e.g., U.S. Pat. No. 5,057,423). In some aspects of the presentinvention, particularly in the use of allogeneic or xenogeneic cells,lower numbers of cells, in the range of 10⁶/kilogram (10⁶-10¹¹ perpatient) may be administered. In certain embodiments, T cells areadministered at 1×10⁵, 1×10⁶, 1×10⁷, 1×10⁸, 2×10⁸, 2×10⁹, 1×10¹⁰,2×10¹⁰, 1×10¹¹, 5×10¹¹, or 1×10¹² cells to the subject. T cellcompositions may be administered multiple times at dosages within theseranges. The cells may be autologous or heterologous to the patientundergoing therapy. If desired, the treatment may also includeadministration of mitogens (e.g., PHA) or lymphokines, cytokines, and/orchemokines (e.g., GM-CSF, IL-4, IL-7, IL-13, FIt3-L, RANTES, MIP1α,etc.) as described herein to enhance induction of the immune response.

In certain embodiments, it may be desired to administer activated Tcells to a subject and then subsequently redraw blood (or have aleukapheresis performed), activate T cells therefrom according to thepresent invention, and reinfuse the patient with these activated andexpanded T cells. This process can be carried out multiple times everyfew weeks. In certain embodiments, T cells can be activated from blooddraws of from 10cc to 400cc. In certain embodiments, T cells areactivated from blood draws of 20cc, 30cc, 40cc, 50cc, 60cc, 70cc, 80cc,90cc, or 100cc. Not to be bound by theory, using this multiple blooddraw/multiple reinfusion protocol, may select out certain populations ofT cells.

The administration of the subject compositions may be carried out in anyconvenient manner, including by aerosol inhalation, injection,ingestion, transfusion, implantation or transplantation. Thecompositions described herein may be administered to a patientsubcutaneously, intradermally, intratumorally, intranodally,intramedullary, intramuscularly, by intravenous (i.v.) injection, orintraperitoneally. In one embodiment, the T cell compositions of thepresent invention are administered to a patient by intradermal orsubcutaneous injection. In another embodiment, the T cell compositionsof the present invention are preferably administered by i.v. injection.The compositions of T cells may be injected directly into a tumor, lymphnode, or site of infection.

In yet another embodiment, the pharmaceutical composition can bedelivered in a controlled release system. In one embodiment, a pump maybe used (see Langer, 1990, Science 249:1527-1533; Sefton 1987, CRC Crit.Ref. Biomed. Eng. 14:201; Buchwald et al., 1980; Surgery 88:507; Saudeket al., 1989, N. Engl. J. Med. 321:574). In another embodiment,polymeric materials can be used (see Medical Applications of ControlledRelease, 1974, Langer and Wise (eds.), CRC Pres., Boca Raton, Fla.;Controlled Drug Bioavailability, Drug Product Design and Performance,1984, Smolen and Ball (eds.), Wiley, New York; Ranger and Peppas, 1983;J. Macromol. Sci. Rev. Macromol. Chem. 23:61; see also Levy et al.,1985, Science 228:190; During et al., 1989, Ann. Neurol. 25:351; Howardet al., 1989, J. Neurosurg. 71:105). In yet another embodiment, acontrolled release system can be placed in proximity of the therapeutictarget, thus requiring only a fraction of the systemic dose (see, e.g.,Medical Applications of Controlled Release, 1984, Langer and Wise(eds.), CRC Pres., Boca Raton, Fla., vol. 2, pp. 115-138).

The T cell compositions of the present invention may also beadministered using any number of matrices. Matrices have been utilizedfor a number of years within the context of tissue engineering (see,e.g., Principles of Tissue Engineering (Lanza, Langer, and Chick(eds.)), 1997. The present invention utilizes such matrices within thenovel context of acting as an artificial lymphoid organ to support,maintain, or modulate the immune system, typically through modulation ofT cells. Accordingly, the present invention can utilize those matrixcompositions and formulations which have demonstrated utility in tissueengineering. Accordingly, the type of matrix that may be used in thecompositions, devices and methods of the invention is virtuallylimitless and may include both biological and synthetic matrices. In oneparticular example, the compositions and devices set forth by U.S. Pat.Nos. 5,980,889; 5,913,998; 5,902,745; 5,843,069; 5,787,900; or 5,626,561are utilized. Matrices comprise features commonly associated with beingbiocompatible when administered to a mammalian host. Matrices may beformed from both natural or synthetic materials. The matrices may benon-biodegradable in instances where it is desirable to leave permanentstructures or removable structures in the body of an animal, such as animplant; or biodegradable. The matrices may take the form of sponges,implants, tubes, telfa pads, fibers, hollow fibers, lyophilizedcomponents, gels, powders, porous compositions, or nanoparticles. Inaddition, matrices can be designed to allow for sustained release seededcells or produced cytokine or other active agent. In certainembodiments, the matrix of the present invention is flexible andelastic, and may be described as a semisolid scaffold that is permeableto substances such as inorganic salts, aqueous fluids and dissolvedgaseous agents including oxygen.

A matrix is used herein as an example of a biocompatible substance.However, the current invention is not limited to matrices and thus,wherever the term matrix or matrices appears these terms should be readto include devices and other substances which allow for cellularretention or cellular traversal, are biocompatible, and are capable ofallowing traversal of macromolecules either directly through thesubstance such that the substance itself is a semi-permeable membrane orused in conjunction with a particular semi-permeable substance.

In certain embodiments of the present invention, cells activated andexpanded using the methods described herein, or other methods known inthe art where T cells are expanded to therapeutic levels, areadministered to a patient in conjunction with (e.g., before,simultaneously or following) any number of relevant treatmentmodalities, including but not limited to treatment with agents such asantiviral therapy, cidofovir and interleukin-2, Cytarabine (also knownas ARA-C) or natalizumab treatment for MS patients or efalizumabtreatment for psoriasis patients or other treatments for PML patients.In further embodiments, the T cells of the invention may be used incombination with chemotherapy, radiation, immunosuppressive agents, suchas cyclosporin, azathioprine, methotrexate, mycophenolate, and FK506,antibodies, or other immunoablative agents such as CAM PATH, anti-CD3antibodies or other antibody therapies, cytoxin, fludaribine,cyclosporin, FK506, rapamycin, mycophenolic acid, steroids, FR901228,cytokines, and irradiation. These drugs inhibit either the calciumdependent phosphatase calcineurin (cyclosporine and FK506) or inhibitthe p70S6 kinase that is important for growth factor induced signaling(rapamycin). (Liu et al., Cell 66:807-815, 1991; Henderson et al.,Immun. 73:316-321, 1991; Bierer et al., Curr. Opin. Immun. 5:763-773,1993; Isoniemi (supra)). In a further embodiment, the cell compositionsof the present invention are administered to a patient in conjunctionwith (e.g., before, simultaneously or following) bone marrowtransplantation, T cell ablative therapy using either chemotherapyagents such as, fludarabine, external-beam radiation therapy (XRT),cyclophosphamide, or antibodies such as OKT3 or CAMPATH. In anotherembodiment, the cell compositions of the present invention areadministered following B-cell ablative therapy such as agents that reactwith CD20, e.g., Rittman. For example, in one embodiment, subjects mayundergo standard treatment with high dose chemotherapy followed byperipheral blood stem cell transplantation. In certain embodiments,following the transplant, subjects receive an infusion of the expandedimmune cells of the present invention. In an additional embodiment,expanded cells are administered before or following surgery.

The dosage of the above treatments to be administered to a patient willvary with the precise nature of the condition being treated and therecipient of the treatment. The scaling of dosages for humanadministration can be performed according to art-accepted practices. Thedose for CAMPATH, for example, will generally be in the range 1 to about100 mg for an adult patient, usually administered daily for a periodbetween 1 and 30 days. The preferred daily dose is 1 to 10 mg per dayalthough in some instances larger doses of up to 40 mg per day may beused (described in U.S. Pat. No. 6,120,766).

EXPERIMENTAL EXAMPLES

The invention is further described in detail by reference to thefollowing experimental examples. These examples are provided forpurposes of illustration only, and are not intended to be limitingunless otherwise specified. Thus, the invention should in no way beconstrued as being limited to the following examples, but rather, shouldbe construed to encompass any and all variations which become evident asa result of the teaching provided herein.

Without further description, it is believed that one of ordinary skillin the art can, using the preceding description and the followingillustrative examples, make and utilize the compounds of the presentinvention and practice the claimed methods. The following workingexamples therefore, specifically point out the preferred embodiments ofthe present invention, and are not to be construed as limiting in anyway the remainder of the disclosure.

Example 1: Treatment and Resolution of PML with Autologous LymphocyteInfusion

A 61-year old male patient was diagnosed with CLL in 1996. Prior therapyincluded fludarabine, rituximab and cyclophosphamide. The patientrelapsed in 2007. In August 2007, the patient presented with brainlesions and hemiparesis diagnostic of PML. Progression was observed byMRI in October 2007.

An initial 130 ml sample of blood from the patient was received on Dec.17, 2007 for preclinical evaluation of compassionate use T cellinfusion. FIG. 1 shows CD45+/CD3+ T cells 10 days post stimulation withanti-CD3/anti-CD28 beads. A compassionate use IND was filed December2007. Apheresis and T cell manufacturing with anti-CD3/CD28 beads wascarried out in a GMP facility according to established methods, such asthose described in U.S. Patent Application Publication No.US20060121005. 1×10¹⁰ autologous CD3/CD28 activated T cells were infusedinto the patient on Feb. 1, 2008.

Results: CD4/CD8 T cell ratio increased from 0.5 to >1.0 after infusion.Absolute CD4 T cell count increased from 200 to 1600 cells/ml. Acommensurate increase in absolute lymphocyte count was observed. Candidadelayed type hypersensitivity reaction (DTH), originally negative,became marginally positive (3 mm).

Clinical parameters: MRI: stable to improved the 10 months postinfusion. A partial resolution of hemiparesis was observed as well asnormalization of performance status.

Flow cytometric analysis of the patient T cells pre and post expansionand post infusion is shown in FIGS. 1-3.

Further analysis of JC virus-specific T cells post-infusion indicated afrequency of IFN-γ⁺, CD69⁺, CD4⁺ and CD8⁺ T cell following JC-LTstimulation of 3.65% and 0.17%, respectively. Following JC-VP1stimulation, the respective frequencies of IFN-γ⁺, CD69⁺, CD4⁺ and CD8⁺T cells were 4.06% and 0.25%. The frequency of IL-2⁺, CD4⁺ and CD8⁺ Tcell following JC-LT stimulation was 3.87% and 1.08%, respectively.Following JC-VP1 stimulation, the respective frequencies of IL2⁺, CD4⁺and CD8⁺ T cells were 3.34% and 0.24%. These are relatively highfrequencies of virus-specific T cells, indicating a healthy JCV-specificimmune reconstitution.

Thus, infusion of activated and expanded autologous T cells resulted inresolution of PML in this patient, suggesting that ALI may be anappropriate therapy for this untreatable disease.

Example 2: CD3/CD28 Beads as Artificial Antigen Presenting Cells (aAPCs)for T Cell Expansion

Progressive multifocal leukoencephalopathy (PML) is a demyelinatingdisease caused by the polyomavirus JC (JCV), which occurs inimmunosuppressed patients (Koralnik, 2006, Ann. Neurol. 60:162-73). Itis a rare disease which results in inflammation of the white matter ofthe brain in multiple locations and carries with it a poor prognosis. Ithas been demonstrated that JCV-specific CD8+ CTLs (specific for twoA*0201-restricted JCV epitopes, VP1(p36) and VP1(p100)) are associatedwith a more favorable outcome in patients with PML (Lima et al., 2007,J. Virol. 81:3361-8) and therefore immunotherapeutic approaches aimed atincreasing the cellular immune response against JCV may be helpful.Without wishing to be bound by any particular theory, it is believedthat CLL patients who are also diagnosed with PML, immune augmentationwill be beneficial to control a JC or JC-like virus infection andprovides additional rationale for the administration of polyclonalactivated T-cells.

T-cell costimulation is critical for induction of full T-cell effectorfunction, and thus represents an attractive immunotherapeutic approachfor the treatment of cancer. The T-cell culture and expansion technologyused in this example includes ex vivo activation of apheresed T-cells isinduced by antibodies to the T-cell receptor complex accessory moleculeCD3 and to the costimulatory receptor CD28, which are both immobilizedon magnetic beads, and provide sufficient signals to drive thelogarithmic growth of T-cells. This system, akin to “artificial antigenpresenting cells,” has proven to be an ideal strategy for rapid andefficient generation of large numbers of activated T-cells and supportsthe most efficient reported growth of human polyclonal naive and memoryCD4+ cells (Levine et al., 1997, J. Immunol. 159:5921-30). In terms ofcell function, the expanded cells retain a highly diverse TCRrepertoire, and, by variation of culture conditions, they can be inducedto secrete cytokines characteristic of T helper 1 (Th1) or T helper 2(Th2) cells. One important advantage of this bead-based system is thatit does not cross-react with CTLA-4, thereby facilitating unopposed CD28stimulation for more efficient expansion of T-cells. Ex vivo expansionmay also indirectly enhance T-cell activity by removing T-cells from atumor-induced immunosuppressive milieu (Bonyhadi et al., 2005, J.Immunol. 174:2366-75; Patten et al., 2005, J. Immunol. 174:6562-3;Renner et al., 1996, Blood 88:236-41; Woo et al., 2001, Cancer Res.61:4766-72).

Bonyhadi et al (2005, J. Immunol. 174:2366-75) developed a method usinganti-CD3/anti-CD28 conjugated beads that preferentially expanded T cellsand eliminated leukemic cells from the CLL patient pool. In the culture,mean T cell composition increased from ˜6% to >90% and leukemic B cellsdecreased from a mean of ˜85% to 0.1% or less. Both activated CD4+ andCD8+ T cell subsets expressed an array of key effector molecules thathave been shown to contribute to potent immune responses, includingCD54, CD134, CD137, and CD154. The T cells were also able to secretelarge amounts of type 1 cytokines such as IFN-γ and TNF-α suggestingthat the CD3/CD28 bead activation process favors the generation of Th1and T cytotoxic (Tc)1 T cells, cell types that are responsible for cellmediated immune responses that are thought to play a major role inantitumor immunity. GM-CSF, which plays an important role in recruitingand promoting the differentiation of APCs, was also produced at highlevels during the entire activation and expansion process. Furthermore,after expansion, there was an increase in the number of tumor-reactive Tcells, the skewing in the TCR repertoire returned to normal, and theactivated T cells had potent in vitro antileukemic effects. Takentogether, this data suggests that the CD3/CD28 bead expanded T cells mayhelp enhance immune responses in vivo.

Based on the above preclinical data, a Phase I/II clinical trial inpatients with advanced CLL was initiated. Patients underwentleukopheresis to collect PBMCs for T cell expansion using the Xcyte™anti-CD3/anti-CD28 Dynabeads. Four patients were treated with a singleinfusion of the “Xcellerated” T cells, three at the 1×10¹⁰ dose and oneat the 3×10¹⁰ dose. The T cells were well-tolerated with no Grade 3 or 4infusional toxicities. The lymphocyte counts on the day of infusion were210, 47, 52 and 16×10³/mm³, and maximal decreases in CD5+CD19+ leukemiccells following infusion were 18%, 31%, 26% or 24% respectively,occurring on days 3, 7, 1 or 1 post-infusion respectively. Absolute Tcell counts prior to treatment were 5.9, 1.8, 2.5, or 1.9×10³/mm³ andincreased in each patient following Xcellerated T Cell infusion, withmaximal increases in each subject of 23%, 96%, 44%, or 82% respectively,occurring at days 21, 14, 14, or 7 post-infusion respectivelyPreliminary data from this trial suggests that a T cell dose of up to3×10¹⁰ cells could reproducibly be expanded from an apheresis unit andsafely administered to CLL patients using a standard operating procedure(SOP) that removes the unwanted leukemic B cells at the start of theculture.

The safety and tolerability of ex vivo activated T-cells have beenevaluated most extensively in CVPF clinical trials of hematologicmalignancies such as leukemia, lymphoma, and myeloma (Laport et al.,2003, Blood 102:2004-13; Rapoport et al., 2004, Bone Marrow Transplant.33:53-60; Rapoport et al., 2005, Nat. Med. 11:1230-7). In addition, thecombination of activated autologous T-cells with chemotherapy (mostnotably alkylating agents) and stem cell transplantation (single andtandem) has been associated with complete and partial responses.Although these data are promising, efficacy that can be attributedspecifically to the reinfusion of activated T-cells must be addressed inlarger randomized clinical trials. Collectively, experience to date fromprotocols in which activated autologous T cell infusions were precededby immune suppression conditioning suggests functional lymphocyterecovery can be achieved in these patients.

In a Phase I study of patients with relapsed or chemotherapy refractoryNon Hodgkin's lymphoma, seventeen patients were treated withCD34+-selected hematopoietic stem cell transplant followed by infusionof autologous peripheral blood T cells stimulated ex vivo with anti-CD3and anti-CD28 beads (Laport et al., 2003, Blood 102:2004-13). Infusionsof the autologous expanded T cells were well tolerated and resulted in arapid reconstitution of lymphocyte counts. Importantly, the expandedcells were functionally superior to those obtained directly from thepatients, as determined by interferon-gamma induction. Maximal clinicalresponses included 5 patients with a complete response, 7 patients witha partial response and 5 patients with stable disease. At a medianfollow-up of 474 days (range=105-1097), 5 patients were alive withstable or relapsed disease and 3 patients remained in complete response.Thus, this Phase I trial demonstrated that adoptive transfer of expandedT-cells (1) is feasible, even in heavily pretreated patients withadvanced non-Hodgkin's lymphoma, (2) may accelerate recovery of the CD4T-cell count, and (3) has minimal to moderate infusion toxicity.

In a current phase I study of patients with purine analog-naiverelapsed/refractory follicular lymphoma, patients are receiving 4 cyclesof fludarabine (25 mg/m²) days 1-3 and cyclophosphamide (250 mg/m²) days1-3. Four weeks after the last cycle of chemotherapy, respondingpatients (CR, CRu, PR) receive escalating doses of adoptive lymphocytetransfer prepared ex vivo from autologous T-cells collected prior tochemotherapy and depleted of CD4⁺ CD25⁺ regulatory T cells, thenactivated and expanded using anti-CD3 and anti-CD28. Thirteen patientshave been enrolled to date. For the 9 assessable patients completingchemotherapy and T cell infusion, 7 patients achieved a completeresponse and 2 pts achieved a partial response. There have been noadverse events related to T-cell infusions, up to a cell dose of 10×10⁹.Median follow-up after T cell infusion is 20 months (range: 2-42months). CD4 counts increased in all patients by 1 month after T-cellinfusion, with a median increase of 3.8 fold (n=8; range: 1.5-71). Forpatients at dose level 1, the median increase was 2.2 fold (n=4; range:1.5-21); at dose level 2, it was 4.2 fold (n=4; range: 3.8-71). CD8counts also increased, with a median increase of 8.1 fold (range:1.0-30). All 9 patients receiving ACTC were anergic to Candida antigenby delayed type hypersensitivity (DTH) skin testing before chemotherapy;5 patients developed a positive DTH response to Candida antigen 60 daysafter T cell infusion. From the start of therapy for patients receivingT-cells, median follow-up is 24 months (range: 6-47) with medianprogression-free survival of 18 months, which is significantly longerthan the time to progression from last therapy (median 11 months)(p=0.01, log-rank test, FIG. 4). More rapid CD4+ and CD8+ lymphocyterecovery is observed in these patients aftercyclophosphamide-fludarabine chemotherapy compared to historicalcontrols, in addition to reconstitution of recall immunity, and arelative reduction of peripheral blood FoxP3+ regulatory T cells.

Two other trials in myeloma have been conducted in which patientsreceive vaccine primed activated T cells after suppression of myeloma byhigh-dose chemotherapy and autologous stem cell rescue (Rapoport et al.,2005, Nat. Med. 11:1230-7). In the first trial, it was observed thatadoptive transfer of in-vivo vaccine-primed and ex-vivo expandedautologous T cells at about day 14 post-transplant increased CD4+ andCD8+ T cell counts at Day+42 post-transplant and induced pneumococcalconjugate vaccine-directed T and B-cell responses. Protective antibodylevels were also established by Day+30, and improved proliferativecapacity of cells to vaccine carrier antigen and to Staphylococcalenterotoxin B was observed. This was the first randomized adoptiveimmunotherapy trial to achieve successful endpoints by demonstratingthat the response to vaccination could be enhanced in the presence ofchemotherapy-induced lymphopenia. In a follow-up Phase I/II trial inwhich twenty one patients to date have received activated autologous Tcells primed against the multipeptide vaccine against telomerase,survivin, and CMV, we have seen no delays in hematopoietic recoveryafter Day+2 transfers of the expanded T cells. In fact, T cell recovery,as measured by quantifying CD3+, CD4+, and CD8+ cells is acceleratedcompared to randomized and historical controls indicating possibleschedule dependency of T cell infusion. The robust T cell counts can beachieved as early as Day+14 post stem cell transplant, with a median CD4count was 1951/mcl (range 651-7668) and the median CD8 count was4117/mcl (range 1499-39,354). The T cell recovery shows sustained levelsabove normal suggesting that early recovery may not be subject to normalhomeostatic mechanisms.

The next set of experiments was designed to use a single dose of 5×10⁹to 2.0×10¹⁰ expanded T-cells, as this dose has been shown to be safe andwell-tolerated in several trials to patients with hematologicmalignancies and HIV. FIG. 4 shows that T cells selected and expandedwith anti-CD3/CD28 beads were able to be expanded at least 4.3population doublings (20-fold) under optimal conditions in small scale.FIG. 5 is a chart demonstrating that T cells selected and expanded withanti-CD3/CD28 beads using the optimal small scale conditions in aclinical scale bioreactor can expand at least 5.22 population doublings(37-fold) under optimal large scale conditions. Furthermore, thepercentage of CD3+ T cells of the CD45+ cells increased from 4.3% in theapheresis product to >99% in the expanded T cell product after 10 daysof culture (FIG. 6). Importantly, the CD19+ cells declined to less than0.5% at Day 10 of culture.

The next set of experiments was designed to determine the safety andfeasibility of an infusion of 5×10⁹ to 2.0×10¹⁰ activated T cellsadministered to the study subject following therapy withfludarabine/cyclophosphamide (fly/cy). The experiments were alsodesigned to determine if administration of expanded T cells followingflu/cy—induced lymphodepletion can improve T lymphocyte numbers. Effectof T cell infusion on immune function, and disease progression andsurvival can be evaluated. Briefly, the methods of the study are asfollows.

The materials and methods employed in these experiments are nowdescribed.

Apheresis Collection

Study subjects undergo steady-state apheresis procedure of 10-12 liters,an amount that is processed on a routine basis, prior to starting asingle course of chemotherapy with fludarabine/cyclosphosphamide. Thegoal for collection is at least 1×10⁹ CD3+ T-cells. Assuming an expectedCD3% of 3-10% of mononuclear cells, at least 15×10⁹ mononuclear cellsshould be collected. Peripheral samples are taken for baselineimmunoassays.

PBMC Enrichment

The apheresis product is first ficoll separated before furtherprocessing to obtain the PBMCs as well as to remove plasma, plateletsand red blood cell contamination.

Positive Selection of CD3+ T-Cells

Following the PBMC enrichment, and real time flow cytometry analysis,approximately 4-8% of CD3+ T-cells, based on a pre-clinical study, aretargeted for positive selection according to an established SOP by usingDynal M450 Tosylactivated magnetic beads conjugated with anti-human CD3and CD28 antibodies at a cell to beads ratio of 1:3 to substantiallyreduce B leukemic cell content from the positively selected CD3+ T-cellpopulation prior to the initiation of ex-vivo culture expansion.

Ex-Vivo Expansion of CD3+ T Cells

After the CD3/28 positive selection, positively selected CD3+ T-cellsare seeded into gas permeable flasks such as the Baxter Lifecell Flaskor a suitable replcement. Cells are grown in X-VIVO media supplementedwith 5% commercial pooled human AB serum. The cells are counted andfresh media added throughout the expansion to maintain cells at anappropriate density.

Final Product Preparation and Release Testing

Cells are expanded ex vivo for up to 11 days and then harvested on thedesignated infusion date. There may be certain circumstances thatrequire that the final product be cryopreserved for thawing and infusionon a later date. Culture samples are taken for flow cytometry,endotoxin, bacterial and fungal testing to determine whether finalproduct release criteria are met. On the harvest day, the microbeads areremoved with a Baxter Fenwal Maxsep® magnetic cell separator. The cellsare then be washed and concentrated with the Baxter Fenwal HarvesterSystem, and resuspended in 100-500 mL 1:1 Plasmalyte A/Dextrose 5%,0.45% NaCl containing 0.5-1% human serum albumin. Cells for lateradditional infusions may be cryopreserved in an infusible media 1:1Plasmalyte A/Dextrose 5%, 0.45% NaCl containing 0.5-1% human serumalbumin, dextran, and 7.5% DMSO. Final products are not released untilall records are reviewed and signed off by the CVPF Quality Manager,CVPF Director, and external Quality Assurance consultant. The expanded Tcells are transported to the subject's bedside, either in the subject'shospital room or at the GCRC.

The criteria for release of the expanded T-cells for reinfusion includeall of the following:

-   -   Minimum cell viability of ≥80% on Final Product (fresh), ≥70%        for cryopreserved product    -   CD3%>80% by FACS on day 7 or later    -   Less than 100 residual microbeads/3×10⁶ cells    -   The number of CLL cells as defined by CD19 expression in the        final infused product will be less than the number of CD19+        cells in the apheresis product    -   No growth of bacterial and fungal cultures sent 96-48 hours        preharvest    -   The gram stain of a sample of the pre-harvest cells must be        negative    -   The endotoxin assay from day −1 or −2 to harvest must be <1        EU/ml or the endotoxin of the final product must be less than 5        EU/kg

In addition, there are a number of post-release follow-up tests on thepre-harvest or final product that are not be available until aftersubject infusion. These include:

Samples Criteria CD3% >80% by FACS Mycoplasma Negative (sample frompre-harvest) Bacterial Negative for growth (sample from final Cultureproduct)) Fungal Culture Negative for growth (sample from final product)Endotoxin <1 EU/ml (sample from final product)

Packaging and Administration

The T cells are administered via intravenous infusion over 20-30 minuteswithout a leukocyte filter. Each infusion bag are affixed to it a labelcontaining the following: “FOR AUTOLOGOUS USE ONLY.” In addition, thelabel have at least two unique identifiers such as the subject'sinitials, birth date, and study number. Prior to infusion, twoindividuals are independently verified for this information.

Screening

The following are performed during the screening visit(s):

-   -   Obtain informed consent prior to proceeding with screening for        eligibility (performed before any other study procedures occur)    -   Confirm a diagnosis of Chronic Lymphocytic Leukemia and        Progressive Multifocal Leukoencephalopahty (PML)    -   Perform a full medical history and physical exam, including        careful review of current medications.    -   Check adequacy of veins for leukapheresis or schedule temporary        pheresis catheter placement    -   Confirm an ECOG performance status <2.    -   Confirm that study subject meets all other inclusion/exclusion        criteria    -   Complete a comprehensive laboratory evaluation, including        complete blood count, blood chemistries, liver function tests,        and PT/PTT    -   DTH intradermal skin test to test for immune response        evaluation. Readout 48 hours later.    -   Imaging studies to determine current disease status (e.g.        CT/MRI/BM Bx as medically indicated).

Chemotherapy

Subjects receive a single course of outpatient conditioninglymphodepletion chemotherapy with intravenous cyclophosphamide (250mg/m²/d for 3 days) and intravenous fludarabine (25 mg/m²/d for 3 days),both administered on days −4 to −2.

Activated T Cell Infusion

Activated T cells are infused ˜2 days after the last dose offludarabine/cyclophosphamide. Prior to the activated T cell infusionsubjects are premedicated with acetaminophen 650 mg PO anddiphenhydramine 25-50 mg PO/IV. Activated T cells are administered viaintravenous infusion over 20-30 minutes without a leukocyte filter.Subjects are observed for 30 minutes after completion of the infusion.Corticosteroids is available at the bedside in the event of anallergic-type reaction but should not be administered on a routinebasis.

Follow Up Day+60

A full medical history and physical exam is performed, including carefulreview of current medications. A comprehensive laboratory evaluation isperformed, including complete blood count, blood chemistries, liverfunction tests. DTH intradermal skin test is conducted to test forimmune recovery. Read-out are taken 48 hours after.

Follow Up Day+180

A full medical history and physical exam is performed, including carefulreview of current medications. A comprehensive laboratory evaluation isperformed, including complete blood count, blood chemistries, liverfunction tests. Imaging studies are conducted to determine diseasestatus (e.g. CT/MRI/BM Bx as medically indicated). Neurologic evaluation(MRI) and viral studies are performed to determine status of PML.

Immunological and PML Assessments

Samples from the apheresis collection at Day −10, and blood draws fromtime of screening (both pre-chemotherapy and used as baseline), Day+60and Day+180 are used for immunological assessments to determine whetherthe administration of expanded T cells improves T lymphocyte numbers andimmune function of the study subject. Samples from standard of careblood draws at Day+7, +14, +21 and Day+30 may also be cryopreserved andused for additional interim assessments if needed. Samples from the bonemarrow biopsy at Day+180 are cryopreserved for future immunoassessments.

DTH-response to Candida albicans or to another suitable recall antigenis measured at baseline and on day 60+/−5 days after T-cell infusion.

Subjects are evaluated by neurology pre and post therapy fordetermination of PML. An MRI can be used for assessment of lesions. JCVp36 and p100 tetramer staining can be used to assess immune response toJC virus.

Lymphocyte Studies

Lymphocyte subsets (CD3/CD4/CD8) are monitored and compared to baseline,using absolute lymphocyte count and flow cytometry. Lymphocyte cytokinestudies are measured pre chemotherapy and 60+/−5 days and 180+/−dayspost T-cell infusion using an automated ELISPOT method to determine thefrequency of T-cells that secrete cytokines (such as IFNγ) after invitro polyclonal stimulation. CD4 T-cell receptor (TCR) repertoireanalysis are done at baseline and then on day 60+/−5 days and 180+/−daysafter T-cell infusion.

Expanded T Cells Following Flu/Cy—Induced Lymphodepletion can Improve TLymphocyte Numbers

Subjects undergo steady-state mononuclear cell apheresis ofapproximately 10-12 liters on the Baxter Amicus or Cobe Spectra. It isdesirable to collect approximately 1×10⁹ T cells or more. Depending onthe study subject's CD3 percent and absolute number, this may correspondto approximately 15-20×10⁹ mononuclear cells or more. Followingapheresis, the subjects undergo a single course of combinationchemotherapy with fludarabine/cyclosphosphamide (intravenouscyclophosphamide (250 mg/m²/d for 3 days) and intravenous fludarabine(25 mg/m²/d for 3 days). The apheresis product is ficoll separated andan initial CD3+ T cell population of approximately 4-8% is targeted forexpansion, depending on the current CD3 percent as measured by flowcytometry. Cells are positively selected and expanded using anti-CD3 andanti-CD28 antibody-coated magnetic beads according to a previouslypublished and validated process (Laport et al., 2003, Blood 102:2004-13;Kalamasz et al., 2004, J. Immunother. 27:405-18) in order tosubstantially reduce leukemic B cell content from the expanded T cellculture and therefore from the final infused product. Approximately twodays after ending flu/cy therapy, the subjects receive one infusion of5×10⁹ to 2.0×10¹⁰ activated T cells. Additional cells may becryopreserved for additional doses if needed. Cell phenotyping isconducted on the pre- and post-expanded T cells, and throughout the10-14 day culture (JCV p36 and p100 tetramer staining, CD3, CD4, CD8,CD28. CD62L, CD40L, CD19). At 60 days after T cell infusion(approximately Day+60), immune recovery is monitored by testingdelayed-type hypersensitivity (DTH) to recall antigen and JCV tetramerstaining and ELISPOT as compared to baseline. Clinical staging by MRIand immune system safety assessments (for autoimmune events) takes place6 months after T cell infusion (approximately Day+180). The generalstudy scheme is depicted in FIG. 7.

Feasibility of the study is partly based on the production of cells thatmeet the minimum release criteria for reinfusion. Besides the standard Tcell product release criteria, an additional CLL minimal residualdisease (MRD) criteria is that that total CLL cells in the expandedproduct as defined by CD19+ be less than the number of CLL cells removedby apheresis. Safety is defined as the incidence of ≥Grade 3treatment-related serious adverse events. Immune recovery is monitoredby comparing to baseline the quantity of lymphocyte subsets, usingabsolute lymphocyte count and flow cytometry. Primary endpointevaluation is based on Day+60 values.

Immune function is assessed by a variety of research based lab assays,including TCR repertoire, T cell mitogen responses, DTH response, andJCV tetramer staining and ELISPOT for cytokine secretion.

The disclosures of each and every patent, patent application, andpublication cited herein are hereby incorporated herein by reference intheir entirety. While this invention has been disclosed with referenceto specific embodiments, it is apparent that other embodiments andvariations of this invention may be devised by others skilled in the artwithout departing from the true spirit and scope of the invention. Theappended claims are intended to be construed to include all suchembodiments and equivalent variations.

1.-12. (canceled)
 13. A method for treating a disease in a subject inneed thereof comprising: (i) administering to the subject an effectiveamount of a chemotherapy, wherein the chemotherapy induceslymphodepletion in the subject; and (ii) administering to the subject aneffective amount of autologous T cells.
 14. The method of claim 1,wherein the autologous T cells are antigen-specific.
 15. The method ofclaim 1, wherein the autologous T cells are activated and expanded. 16.The method of claim 1, wherein the disease is a cancer.
 17. The methodof claim 16, wherein the cancer is chronic lymphocytic leukemia.
 18. Themethod of claim 1, wherein the disease is progressive multifocalleukoencephalitis.
 19. The method of claim 1, wherein the chemotherapyis administered following apheresis.
 20. The method of claim 1, whereinthe chemotherapy is administered intravenously.
 21. The method of claim1, wherein the chemotherapy is administered daily for three days. 22.The method of claim 1, wherein the chemotherapy comprisescyclophosphamide and/or fludarabine.
 23. The method of claim 1, whereinthe chemotherapy comprises cyclophosphamide at about 250 mg/m²/day. 24.The method of claim 1, wherein the chemotherapy comprises fludarabine atabout 25 mg/m²/day.
 25. The method of claim 1, wherein the autologous Tcells are administered after administering the chemotherapy.
 26. Themethod of claim 25, wherein the autologous T cells are administered twodays after ending administration of the chemotherapy.
 27. A method forimproving T cell numbers in a subject comprising: (i) administering tothe subject an effective amount of a chemotherapy, wherein thechemotherapy induces lymphodepletion in the subject; and (ii)administering to the subject an effective amount of autologous T cells.28. A method for treating chronic lymphocytic leukemia or follicularlymphoma in a subject in need thereof comprising: (i) administering tothe subject an effective amount of a chemotherapy comprisingcyclophosphamide and fludarabine, wherein the chemotherapy induceslymphodepletion in the subject; and (ii) administering to the subject aneffective amount of autologous T cells.
 29. The method of claim 28,wherein the autologous T cells are antigen-specific.
 30. The method ofclaim 28, wherein the autologous T cells are activated and expanded. 31.The method of claim 28, wherein the chemotherapy comprisescyclophosphamide at about 250 mg/m²/day and fludarabine at about 25mg/m²/day.
 32. The method of claim 28, wherein the autologous T cellsare administered after administering the chemotherapy.